Objective: To analyze the healthcare burden and incidence of Tardive dyskinesia (TD) due to antipsychotic dose reduction in patients with bipolar disorder (BD) and major depressive disorder (MDD).

Background: Antipsychotics are often used to treat mood disorders, such as BD and MDD. Tardive dyskinesia (TD), an often-irreversible movement disorder, may develop after antipsychotic exposure. Typically, clinicians reduce antipsychotic dose to manage TD; however, benefits and risks of dose reductions have not been well studied.

Methods: Medical claims from six US states spanning 6 years were retrospectively analyzed for ≥10% or ≥30% antipsychotic dose reductions versus those from patients receiving stable doses. Outcomes measured were inpatient admissions and emergency room (ER) visits for BD/MDD, all psychiatric disorders, and all causes. Additional analyses were done to evaluate antipsychotic dose reduction with respect to the prevalence of TD.

Results: There were 23,992 and 17,766 cases in the BD and MDD populations, respectively. Patients with ≥10% dose reduction had an increased risk of admission or ER visit for BD (hazard ratio [HR] 1.22; 95% CI 1.15, 1.31; P<0.001), MDD (HR 1.22; 95% CI 1.11, 1.34; P<0.001) and all psychiatric disorders (BD: HR 1.19; 95% CI 1.13, 1.24; P<0.001 and MDD: HR 1.17; 95% CI 1.11, 1.23; P<0.001) versus controls. Furthermore, BD and MDD patients with ≥10% dose reduction had increased risk of an all-cause inpatient admission or ER visit. Antipsychotic dose reduction of ≥10% was not shown to reduce the incidence of TD in MDD (Number of events = 18; HR 2.34; 95% CI 1.05, 5.21; P=0.04) or BD (Number of events = 17; HR 1.95; 95% CI 0.90, 4.22; P=0.09) patients who did not have TD at baseline. There were similar findings in those patients who had a ≥30% dose reduction.

Conclusions: Results showed significant increases in all-cause and mental health–related hospitalizations/ER visits, suggesting that antipsychotic dose reductions may increase overall healthcare burden in BD and MDD patients. In patients without TD at baseline and a dose reduction in their antipsychotic, results did not show a relationship in antipsychotic dose reduction and a reduction in TD incidence. Future analyses should robustly examine this relationship between antipsychotic dosing and the incidence of TD in larger patient populations to overcome the limitation of the small number of events in the current dataset. There is a need for a TD treatment option that does not disrupt optimal antipsychotic regimens.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hospital-utilization-rates-following-antipsychotic-dose-reductions-among-patients-with-bipolar-and-major-depressive-disorders/