Novel Antipsychotics for Dementia-Associated Agitation

March 31, 2003

OTTAWA - The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) released a technology report today on the use of novel antipsychotic drugs for the treatment of dementia-associated agitation (DAA).

The report critically examines the evidence on the efficacy and safety of novel antipsychotic drugs for rapid (within 2 hours) and longer term (6 to 12 weeks) reduction of DAA as compared to placebo and conventional antipsychotic drugs.

The incidence of dementia in Canada is increasing as the population ages. Dementia includes changes in behaviour and can involve progressive loss of intellectual abilities such as language, comprehension, memory and learning. It can also increase agitation. DAA causes stress for caregivers and affects quality of life for patients.

Novel antipsychotics are a new generation of drugs developed to overcome the significant side effects, such as extra pyramidal symptoms (EPS), associated with conventional antipsychotic drugs.

Although four novel antipsychotic drugs are available in Canada, CCOHTA's systematic review of the literature identified relevant publications on only two novel antipsychotic drugs - risperidone and olanzapine. The report concludes:

• For rapid reduction of DAA, intramuscular olanzapine was as efficacious as the lorazepam (a benzodiazepine) and more efficacious than placebo in nursing home patients with DAA. Adverse events at 24 hours for olanzapine, lorzepam and placebo were the same.
• Over a 12-week period, risperidone had similar efficacy to the conventional antipsychotic drug haloperidol, but patients on haloperidol had more frequent and severe EPS.
• Over the longer term (6 to 12 weeks), the evidence regarding the efficacy of olanzapine and risperidone compared to placebo was variable: newer larger trials showed benefit whereas older trials did not. Both drugs increased some types of side effects.
• Novel antipsychotics are expensive drugs, relative to more established alternatives. Cost-effectiveness analyses may clarify relative costs and benefits.

CCOHTA is a private not-for-profit health research organization that provides unbiased, reliable information about health technology. CCOHTA is funded by the federal, provincial and territorial governments. CCOHTA also manages a common review process for new drugs submitted for funding through participating federal, provincial and territorial drug benefit programs.

For further information contact Kirk Fergusson: 613 226-2553 ext. 276