Comparative effectiveness of monotherapy with mood stabilizers versus second generation (atypical) antipsychotics for the treatment of bipolar disorder in children and adolescents

ABSTRACT Objective This study compared the effectiveness and safety of second generation (atypical) antipsychotic (SGA) versus traditional mood stabilizers (MS) in children and adolescents with bipolar disorder. Methods The study was a retrospective cohort study on 5 years (2003–2007) of Medicaid claims data from four geographically diversified states. Children and adolescents aged 6–18 years who initiated a new treatment episode for bipolar disorder on either an SGA or an MS were followed for 12 months to compare the effectiveness and safety between the two therapeutic categories for pediatric bipolar disorder (PBD). The outcome measures were psychiatric hospital admission, all cause medication discontinuation and treatment augmentation. Potential selection bias caused by unobserved confounding was addressed with instrumental variable methods, using physician prescribing preference and year of cohort entry as the instruments. Sensitivity analysis was conducted to test the robustness of findings against the uncertainties on PBD diagnosis. Results Of the 7423 bipolar children and adolescents identified, 66.60% started treatment on SGA, whereas 33.40% initiated on MS. Patients who initiated on MS and SGA had comparable risk of psychiatric hospital admission (HR = 1.172, 95%CI: 0.827–1.660). However, as compared with those who initiated on MS, patients who initiated on SGA were less likely to discontinue the treatment (HR = 0.634, 95%CI: 0.419–0.961) and less likely to receive treatment augmentation (HR = 0.223, 95%CI: 0.103–0.484). Conclusion As compared with MS monotherapy, SGA monotherapy could be a more effective and safer treatment option for PBD. Copyright © 2014 John Wiley & Sons, Ltd.