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Seroquel-quetiapine Prescriptions Drop 15% After Dementia Warning

"People with dementia living in nursing homes and in the community were prescribed less and we did not detect negative health impacts for these groups."
Pharmacist getting Seroquel

Warning letters from Medicare can safely cut prescribing of a powerful but risky antipsychotic, according to a new study at Columbia University Mailman School of Public Health.

The antipsychotic Seroquel® (generic name is quetiapine) is widely prescribed in dementia to help with behavioral and mood issues. Medicare recently sent out warning letters about using the drug in dementia. Next, researchers used Medicare data to study the effects of the letters on hundreds of thousands of older adults with dementia. They found a significant and lasting reduction in prescribing but no signs of adverse effects on patient health. The findings are published in JAMA Network Open.

Low-Cost Letters with High Impact

“Our study shows that low-cost letter interventions can safely reduce antipsychotic prescribing to patients with dementia,” said Adam Sacarny, PhD, assistant professor of Health Policy and Management at Columbia Mailman School. The work was conducted with researchers at the London School of Economics, Harvard T.H. Chan School of Public Health and Johns Hopkins University.

The researchers evaluated a large trial in which Medicare sent warning letters to high prescribers of quetiapine, the most popular antipsychotic in the USA. Antipsychotics are frequently prescribed to people with dementia, but can cause numerous harms in this group. Researchers therefore studied the hundreds of thousands of older adults with dementia who were treated by the prescribers in the trial. Most previous studies on reducing prescribing in dementia care consisted of small trials or observational analyses, with limited evidence from large-scale randomized studies.

Striking Results, No Negative Impact

The results were striking. “People with dementia living in nursing homes and in the community were prescribed less and we did not detect negative health impacts for these groups,” said Michelle Harnisch, research student at the London School of Economics and first author of the study.

The findings are important because antipsychotics, such as quetiapine, are often used in dementia care to address behavioral symptoms. About 1 in 7 nursing home residents receives an antipsychotic every quarter.

Cutting Risks

However, antipsychotic drugs have a number of well-known risks. These include:

  1. Weight gain,
  2. Cognitive decline,
  3. Falls, and
  4. Death.

In turn, physician specialty societies, government regulators, and policymakers have aimed to reduce prescribing of these medications to people with dementia.

Big Study

To test whether the warning letters reduced prescribing safely, the researchers used administrative data from Medicare to link the 5,055 physicians in the original trial to the Medicare records of their patients with dementia. They ultimately analyzed 84,881 patients in nursing homes and 261,288 patients living in the community.

The intervention reduced quetiapine use as follows:

  • Nursing home patients by 7 percent and
  • Community-dwelling patients by 15 percent.

Few Adverse Effects, Improved Mental Health

The researchers:

  1. Did not find adverse effects across numerous health outcomes, including cognitive function, behavioral symptoms, depression, or metabolic outcomes like diabetes.
  2. There were signs of improved mental health outcomes, and
  3. The risk of death for patients living in the community fell slightly.

This research follows up on the original evaluation of the warning letters. In that study, members of the same research team also showed that the letters reduced prescribing. However, they focused on a considerably smaller sample of patients and studied a limited set of health outcomes. In contrast, the new research evaluates a number of key health indicators for dementia care and substantially expands the patient sample with a focus on dementia.

Safer Prescribing, Better Dementia Care

“These results show that this intervention and others like it could be leveraged to make prescribing safer and improve dementia care” noted Sacarny. “Similar interventions could also be adapted to other contexts to promote high-quality care.”

More Information:

  • Co-authors are Michael L. Barnett, Stephen Coussens, Kali S. Thomas, Mark Olfson, and Kiros Berhane.
  • The study was supported by the National Institute on Aging (R21-AG070942).

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3 Comments
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Cheryl Devine
Cheryl Devine
May 22, 2024 3:33 pm

My 32 year son takes quetiapine for bipolar disorder. Will this effect him in the future?

Carroll
Carroll
Reply to  Cheryl Devine
May 28, 2024 4:56 pm

All I know know is that I was given it for depression for 20 years. I started having hallucinations and black outs. I requested I come off Seroquel and have not had a hallucination or black out since that was 5 years ago.

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P. Berger

This site was inspired by my Mom’s autoimmune dementia.

It is a place where we separate out the wheat from the chafe, the important articles & videos from each week’s river of news. Google gets a new post on Alzheimer’s or dementia every 7 minutes. That can overwhelm anyone looking for help. This site filters out, focuses on and offers only the best information. it has helped hundreds of thousands of people since it debuted in 2007. Thanks to our many subscribers for your supportive feedback.

The site is dedicated to all those preserving the dignity of the community of people living with dementia.

Peter Berger, Editor

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This site was inspired by my Mom’s autoimmune dementia.

It is a place where we separate out the wheat from the chafe, the important articles & videos from each week’s river of news. Google gets a new post on Alzheimer’s or dementia every 7 minutes. That can overwhelm anyone looking for help. This site filters out, focuses on and offers only the best information. it has helped hundreds of thousands of people since it debuted in 2007. Thanks to our many subscribers for your supportive feedback.

The site is dedicated to all those preserving the dignity of the community of people living with dementia.

Peter Berger, Editor

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This site was inspired by my Mom’s autoimmune dementia.

It is a place where we separate out the wheat from the chafe, the important articles & videos from each week’s river of news. Google gets a new post on Alzheimer’s or dementia every 7 minutes. That can overwhelm anyone looking for help. This site filters out, focuses on and offers only the best information. It has helped hundreds of thousands of people since it debuted in 2007. Thanks to our many subscribers for your supportive feedback.

The site is dedicated to all those preserving the dignity of the community of people living with dementia.

Peter Berger, Editor

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