Descriptive analysis of the use of atypical antipsychotics under compassionate-use in a health area in Ferrol (La Coruña, Spain)

Although atypical antipsychotics (AA) provoke fewer extrapyramidal symptoms (ES) than classic antipsychotics, their use in patients greater than or equal to 75 years old with dementia must be under compassionate-use. This is an important limitation. We performed a descriptive analysis of the use of atypical antipsychotics under compassionate-use (AACU) in the Ferrol health area. We retrospectively assessed all the patients who were receiving an AACU from March, 2004 (that is the date when prescription under compassionate-use of AA came into force in Spain) to 30 November, 2008. One hundred and thirty-three of 164 patients (63.6% women; median ages, 81.9±4.95 years) were included. Diagnostic aetiologies were: 42.9% Alzheimer disease, 30.8% Parkinson-dementia/Lewy body disease, and 15.8% vascular/mixed dementia. A total of 68.4% of patients had received other anti-psychotic drugs previously and 32.3% had ES due to antipsychotics. The AACU received were: quetiapine (76.7%), ziprasidone (18.8%), and olanzapine (4.5%). Median follow-uptime was 20.25±20.38 months. Side effects were observed in 19.7% of patients. Improvement of NPI (Neuropsychiatric Inventory) was 33.3±24.75 points. Agitation/aggressiveness (5.6±4.55), delirious ideas (4.94±5.07), irritability (4.38±4.94), and anxiety (4.32±4.83) were the symptoms that most improved. Although there were no differences between AACU, quetiapine was associated with significant maintenance in monotherapy (94.1% vs 72% for ziprasidone and 83.3% for olanzapine; p < 0.0001). AACU are effective and well tolerated drugs. Quetiapine was the most frequently used AACU. An excessive percentage of patients previously received other antipsychotics and present with ES. Aunque quetiapina y ziprasidona producen menos síntomas extrapiramidales (SEP) que otros antipsicóticos, su uso en pacientes mayores de 75 años con demencia se ve condicionado por la obligatoriedad de prescribirlos “por uso compasivo”. Realizamos un análisis descriptivo del uso de antipsicóticos atípicos de uso compasivo (AAUC) en el área sanitaria de Ferrol. Incluimos a todos los pacientes que recibieran un AAUC desde marzo de 2004 (fecha en que entró en vigor la dispensación de AAUC) hasta el 30-11-2008. Se incluyó a 133 de un total de 164 pacientes (el 63,6%, mujeres; media±desviación estándar de edad, 81,9 ± 4,95 años). El 94,1% presentaba demencia (el 42,9%, enfermedad de Alzheimer; el 30,8%, demencia-enfermedad de Parkinson, y el 15,8%, demencia vascular/mix