Patients with Parkinson disease (PD) who use inappropriate antipsychotics may be at increased risk for pneumonia compared with patients with PD who use more appropriate atypical antipsychotic (AAP) medications, study results published in the Journal of Psychiatric Research suggests.
Individuals with a PD diagnosis and comorbid depression (mean age 82.15 years; SD 6.97 years) who initiated an AAP medication were included in this study (n=12,076). Researchers included data from the 2007 to 2009 Minimum Data Set crosslinked to Chronic Condition Warehouse Medicare files.
The primary objective was to identify whether the use of inappropriate AAPs for PD was associated with an increased risk for pneumonia. Appropriate AAPs included aripiprazole, clozapine, or quetiapine, whereas inappropriate AAPs were olanzapine, asenapine, brexpiprazole, iloperidone, lurasidone, paliperidone, risperidone, or ziprasidone.
Inappropriate AAPs were associated with higher pneumonia incidence rates per person-year compared with appropriate medications (45.92 vs 37.19, respectively). In the adjusted Cox proportional hazards model, there was an increased pneumonia risk in nursing home residents who used inappropriate AAPs (hazard ratio [HR], 1.20; 95% CI, 1.08-1.34; P <.01).
Sensitivity analysis found the risk for pneumonia was higher with risperidone use vs quetiapine use (HR, 1.28; 95% CI, 1.12-1.47; P <.01). There was also a higher risk for pneumonia with the use of olanzapine vs quetiapine (HR, 1.29; 95% CI, 1.06-1.57; P <.01).
Study limitations included the reliance on administrative data and the lack of data on PD severity.
The researchers concluded that findings from this study “suggest that selection of AAPs in PD is critical to prevent serious adverse events related to antipsychotic use in PD, given that pneumonia is one of the most common causes of mortality” in patients with PD. They add that there is a need for further research “to evaluate the risk of pneumonia in [patients with PD] using newer antipsychotic medications.”
Chekani F, Holmes HM, Johnson ML, et al. Risk of pneumonia associated with atypical antipsychotic use in nursing home residents with Parkinson’s disease. J Psychiatr Res. 2019;117:116-121.