Off-label use of low-dose quetiapine for MACE and more

World PsychiatryScott Cunningham MD PhD, et al. | September 12, 2022

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It is well-known that patients prescribed standard doses of quetiapine gain weight and have increased levels of triglycerides, total cholesterol, and low-density lipoprotein-cholesterol.

The current study clearly showed that off-label use of low-dose quetiapine as an anxiolytic/hypnotic is associated with increased risk of MACE and cardiovascular death when compared to Z-drugs or selective serotonin reuptake inhibitors (SSRIs).

A nationwide study was conducted in Denmark between 2003 and 2017 to determine the risk of MACE and cardiovascular deaths among new users of off-label low-dose quetiapine or Z-drugs. Patients with a history of ischemic stroke, myocardial infarction, cancer, or severe mental illness were excluded.

The risks of MACE, ischemic stroke, and cardiovascular death were increased in patients prescribed off-label low-dose quetiapine (n=60,566) compared to Z-drugs (n=454,567).

Specifically, based on the intention-to-treat analysis, the adjusted hazard ratio (aHR) was 1.13 and 1.26 for MACE and cardiovascular death, respectively. The aHRs in the as-treated analysis was 1.52, 1.37, and 1.90 for MACE, ischemic stroke, and cardiovascular death, respectively. The aHRs in the sensitivity analysis using SSRIs as a comparator were 1.42, 1.27, and 1.72 for MACE, ischemic stroke, and cardiovascular death, respectively.

The aHRs for MACE were increased for women (1.28) and patients > 65 years of age (1.24).

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