Hayes, J.F. et al | 2019 | Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type Calcium Channel Antagonists, and Biguanides With Rates of Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness | JAMA Psychiatry | Published online ahead of print| doi:10.1001/jamapsychiatry.2018.3907
A study that involved experts from University College London has been published in JAMA Psychiatry, following its finding that hospital treatment for patients with serious mental illness was reduced by up to a fifth when they were prescribed drugs in common use for physical health problems.
The study investigated if drugs in common use for physical health problems are associated with reduced rates of psychiatric hospitalization and self-harm in individuals with serious mental illness.
The researchers analysed the patient information of 142 691 patients with bipolar disorder, schizophrenia, or nonaffective psychosis. It found that the drugs used to treat blood pressure, high cholesterol and type 2 diabetes were found to have the potential to treat severe mental illness as it was associated with reduced rates of psychiatric hospitalizaiton compared with unexposed periods. Self-harm was reduced in patients with bipolar disorder and schizophrenia during exposure to all study drugs and in patients with nonaffective psychosis taking L-type calcium channel antagonists.
Importance Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI).
Objective To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI.
Design, Setting, and Participants These within-individual cohort studies of patients with SMI compared rates of psychiatric hospitalization and self-harm during periods of exposure and nonexposure to the study drugs, with adjusting for a number of time-varying covariates. Participants included 142 691 individuals from the entire population of Sweden with a diagnosis of bipolar disorder (BPD), schizophrenia, or nonaffective psychosis (NAP) who were 15 years or older and who were treated with psychiatric medication from October 1, 2005, through December 31, 2016. Data were analyzed from April 1 through August 31, 2018.
Interventions Treatment with HMG-CoA RIs, LTCC antagonists, or biguanides.
Main Outcomes and Measures Psychiatric hospitalizations and self-harm admissions.
Results Among the 142 691 eligible participants, the HMG-CoA RI exposure periods were associated with reduced rates of psychiatric hospitalization in BPD, schizophrenia, and NAP and reduced self-harm rates in BPD and schizophrenia. Exposure to LTCC antagonists was associated with reduced rates of psychiatric hospitalization and self-harm in subgroups with BPD, schizophrenia and 0.30, respectively), and NAP and 0.56, respectively). During biguanide exposure, psychiatric hospitalization rates were reduced in subgroups with BPD, schizophrenia, and NAP, and self-harm was reduced in BPD and schizophrenia.
Conclusions and Relevance This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.
The article is available from JAMA Psychiatry
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