Diabetes mellitus risk for 102 drugs and drug combinations used in patients with bipolar disorder.

Abstract

OBJECTIVE:

To compare the largest set of bipolar disorder pharmacotherapies to date (102 drugs and drug combinations) for risk of diabetes mellitus (DM).

METHODS:

The IBM MarketScan® database was used to retrospectively analyze data on 565,253 adults with bipolar disorder without prior glucose metabolism-related diagnoses. The pharmacotherapies compared were lithium, mood-stabilizing anticonvulsants, antipsychotics, and antidepressants (monotherapy and multi-class polypharmacy). Cox regression modeling included fixed pre-treatment covariates and time-varying drug exposure covariates to estimate the hazard ratio (HR) of each treatment versus "No drug".

RESULTS:

The annual incidence of new-onset diabetes during the exposure period was 3.09 % (22,951 patients). The HR of drug-dependent DM ranged from 0.79 to 2.37. One-third of the studied pharmacotherapies, including most of the antipsychotic-containing regimens, had a significantly higher risk of DM compared to "No drug". A significantly lower DM risk was associated with lithium, lamotrigine, oxcarbazepine and bupropion monotherapies, selective serotonin reuptake inhibitors (SSRI) mono-class therapy and several drug combinations containing bupropion and an SSRI. As additional drugs were combined in more complex polypharmacy, higher HRs were consistently observed.

CONCLUSIONS:

There is an increased risk of diabetes mellitus associated with antipsychotic and psychotropic polypharmacy use in bipolar disorder. The evidence of a lower-than-baseline risk of DM with lamotrigine, oxcarbazepine, lithium, and bupropion monotherapy should be further investigated.

• Authors: Anastasiya Nestsiarovich, Berit Kerner, Aurélien J Mazurie, Daniel C Cannon, Nathaniel G Hurwitz, Yiliang Zhu, Stuart J Nelson, Tudor I Oprea, Annette S Crisanti, Mauricio Tohen, Douglas J Perkins, Christophe G Lambert
• Journal: Psychoneuroendocrinology (Psychoneuroendocrinology) Vol. 112 Pg. 104511 (02 2020) ISSN: 1873-3360 [Electronic] England
• PMID: 31744781 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Anticonvulsants
• Antidepressive Agents
• Antimanic Agents
• Antipsychotic Agents
• Lithium Compounds

Topics

• Adolescent
• Adult
• Anticonvulsants (adverse effects)
• Antidepressive Agents (adverse effects)
• Antimanic Agents (adverse effects)
• Antipsychotic Agents (adverse effects)
• Bipolar Disorder (drug therapy, epidemiology)
• Databases, Factual
• Diabetes Mellitus (chemically induced, epidemiology)
• Drug Therapy, Combination (adverse effects)
• Female
• Humans
• Incidence
• Lithium Compounds (adverse effects)
• Male
• Middle Aged
• Polypharmacy
• Retrospective Studies
• Risk
• United States (epidemiology)
• Young Adult