Lead Biostatistician Holmusk Inc., Singapore, Singapore
Background: Patients on typical antipsychotics are known to experience neurological side effects like extrapyramidal symptoms. Atypical antipsychotics have lower affinity occupancy for the dopaminergic receptors, and a high degree of occupancy of the serotoninergic receptors 5-HT2A, therefore inducing fewer extrapyramidal symptoms. Minimizing medication side effects are important in improving treatment adherence.
Objectives: In this study, we aim to leverage a large electronic health database to generate real-world insights on the burden of known side effects of typical and atypical antipsychotics, as well as positive and negative symptoms of schizophrenia.
Methods: This study was conducted using de-identified data collected from NeuroBlu, a longitudinal electronic health database consisting of more than 25 mental health providers in the United States between 2000 to 2020. Patients with a diagnosis of schizophrenia and prescribed antipsychotics for >7 days were sampled from the database. All patients had Clinical Global Impression-Severity (CGIS) and Global Assessment of Functioning (GAF) readings at baseline , and were followed up to +/- 1 year of their schizophrenia diagnosis. Patients without continuous typical or atypical antipsychotic treatment were omitted from the analysis. Patients’ mental state were derived from clinical notes using Natural Language Processing techniques and where our main outcome measures sedative, extrapyramidal and anxiety/agitation side effects, and schizophrenia symptoms were extracted from. Propensity score matching (PSM) was used to balance the treatment groups, and we compared the outcomes post-balancing.
Results: A total of 2727 patients were included in the final analysis. Out of which, 364 (13.3%) were in the typical antipsychotic group and 2363 (86.7%) in the atypical antipsychotic group. Patients on atypical antipsychotics were on average younger than those on typical antipsychotics (Median age: 36 vs 44; p< 0.05). Typical antipsychotics were found to be more common in the Black and African American population while atypical antipsychotics were more common in the White population. Patients on typical antipsychotics had statistically higher prevalence of MDD, SUD, bipolar disorder, and schizoaffective disorder. After PSM, there was no record of extrapyramidal symptoms in 534 (73.4%) patients during the 1 year follow-up period. In contrast, there were 126 (17.3%) patients with more than 3 records of extrapyramidal symptoms. However, this finding was not statistically different between the antipsychotic groups (p=0.93). In addition, we did not find any evidence that the occurrence of anxiety/agitation and sedative side effects were different between the antipsychotic groups. Schizophrenia symptom burden were also similar with 476 (65.4%) and 431 (59.2%) patients that experienced more than 3 positive symptoms and negative symptoms respectively.
Conclusions: Our results show that the burden of sedative, anxiety/agitation and extrapyramidal side effects, and schizophrenia symptoms were similar between typical and atypical antipsychotics.
