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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

Variation in the safety and effectiveness of antipsychotic medications by race and ethnicity among Medicare beneficiaries with schizophrenia

Heterogeneity of safety and effectiveness of antipsychotic drugs across racial and ethnic medicare beneficiaries with schizophrenia

Among older Medicare beneficiaries with schizophrenia, there was no difference in treatment discontinuation between quetiapine and olanzapine, while quetiapine was associated with a slightly lower risk of death, with a more pronounced difference among Hispanic beneficiaries.

The study aimed to estimate the causal effects of olanzapine versus quetiapine on effectiveness and safety in older adults with schizophrenia and to assess whether these effects varied by dementia status and race/ethnicity. US fee-for-service Medicare beneficiaries aged 66 years and older with a diagnosis of schizophrenia who initiated olanzapine or quetiapine between 2017 and 2021 were followed for 18 months for all-cause treatment discontinuation (effectiveness) and death (safety). Risk differences comparing outcomes if all beneficiaries had received quetiapine versus olanzapine were estimated using nonparametric machine learning, while subgroup effects were estimated using transfer causal learning. Among 7,049 beneficiaries receiving olanzapine and 14,831 receiving quetiapine, the mean age was 79 years (SD 8.6); 12% were Black, 6.6% were Hispanic, 77% were White, and 61% had dementia. At 18 months, mortality was 31% and treatment discontinuation was 50%. The risk difference for treatment discontinuation (quetiapine minus olanzapine) was 0.0 percentage points (95% CI: -1.43 to 1.42), ranging from -1.6 (-3.71 to 0.0) among those with dementia to 1.8 (-0.50 to 3.38) among those without dementia. The risk of death was 1.3 percentage points lower with quetiapine (95% CI: -2.6 to 0.03). Among Hispanic beneficiaries, transfer causal learning estimated a mortality difference of -5.9 percentage points (95% CI: -11.57 to -0.24), while dementia did not modify the effect on mortality. The authors present this study as the first causal evidence that the safety and effectiveness of antipsychotics may vary by race/ethnicity and dementia status, noting that the mortality difference among Hispanic beneficiaries may reflect mechanisms affecting cardiovascular risk or differences in dose or treatment duration.

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