Could Antipsychotics Raise Pneumonia Risk in Alzheimer Patients?

Researchers from the University of Eastern Finland have found a connection between the use of antipsychotic medications and a higher risk of pneumonia in individuals with Alzheimer disease.

While pointing out that antipsychotics have been linked to increased risk of pneumonia, for which those with dementia are particularly susceptible, the authors also note that just 1 small study had previously assessed the risk of pneumonia in relation to antipsychotic use among individuals with Alzheimer disease.
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The investigators sought to evaluate whether incident antipsychotic use, or specific antipsychotics are related to higher risk of hospitalization or death due to pneumonia in the MEDALZ cohort, which included all persons with Alzheimer disease who received a clinically verified Alzheimer diagnosis in Finland between the years 2005 and 2011.

Overall, the study included 60,584 patients with a verified diagnosis of Alzheimer disease. A matched comparison cohort without Alzheimer disease was used to compare the magnitude of risk, with the researchers adjusting for a propensity score derived from comorbidities, concomitant medications, and sociodemographic characteristics. Sensitivity analyses with case-crossover design were conducted as well.

The researchers found that antipsychotic use was associated with higher pneumonia risk in the Alzheimer disease cohort and a "somewhat higher" risk in the non-Alzheimer cohort, and observed similar results with case-crossover analyses in the Alzheimer cohort. The 3 most commonly used antipsychotics (quetiapine, risperidone, haloperidol) had similar associations with pneumonia risk.

The findings “support current treatment guidelines on setting a high threshold for initiating antipsychotic use among persons with Alzheimer disease, and the risks and benefits should be weighted carefully,” says study co-author Anna Maija Tolppanen, PhD, an associate professor at the University of Eastern Finland. “If antipsychotic use is initiated, the duration should be limited as the risk of pneumonia—neither the risk of other adverse outcomes—does not disappear with long-term use.”

—Mark McGraw

Reference

Tolppanen AM, Koponen M, Tanskanen A, et al. Antipsychotic use and risk of hospitalization or death due to pneumonia in persons with and without Alzheimer's disease [published online June 10, 2016]. Chest. doi:10.1016/j.chest.2016.06.004.