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Saito K, Kuge R, Nagasawa T, Ohkura T, Miura M. QT prolongation is over-estimated by Bazett compared to Friderica in Japanese child and adolescent inpatients. Int Clin Psychopharmacol 2021; 36:268-273. [PMID: 34054113 DOI: 10.1097/yic.0000000000000365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent researches suggested that the risk of drug-induced QTc prolongation is low in child and adolescent psychiatry setting. However, these cohorts enrolled mainly of Caucasian background. We aimed to assess the prevalence of QTc prolongation and its association with antipsychotic use in Japanese youth. The medical records of inpatients were reviewed. Two different definitions of QT prolongation, Bazett's corrected QT interval (QTcB) >450 msec and Fridericia's corrected QT interval (QTcF) >450 msec, were adopted. In 220 participants [age: 13.4 ± 2.3 years, antipsychotics according to the chlorpromazine equivalence: 50 (25th-75th percentiles; 0-150) mg/day], the prevalence of QTcB and QTcF prolongation was 13.6 and 2.3%, respectively. Patients with QTcB >450 msec had a significantly higher heart rate than those with QTcB ≤450 msec (91.2 ± 20.6 bpm vs. 76.1 ± 15.2 bpm; P < 0.001). The other variables, except potassium level (4.1 ± 0.4 mEq/L vs. 4.2 ± 0.3 mEq/L; P = 0.030), showed no significant difference. Clinically meaningful QTc prolongation was rare even in this Japanese cohort. This study also suggested that if QTcB is used, clinicians should be aware of possible overdiagnosis of QTc prolongation due to accelerated heart rate.
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Affiliation(s)
- Kei Saito
- Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical Center, Tokyo
| | - Rie Kuge
- Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical Center, Tokyo
- Mental Health Clinic for Children, Shinshu University Hospital, Nagano
| | - Takashi Nagasawa
- Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical Center, Tokyo
| | - Takeshi Ohkura
- Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical Center, Tokyo
| | - Masaru Miura
- Department of Pediatric Cardiology, Tokyo Metropolitan Children's Medical Center
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Cicala G, Barbieri MA, Santoro V, Tata C, Colucci PV, Vanadia F, Drago F, Russo C, Cutroneo PM, Gagliano A, Spina E, Germanò E. Safety and Tolerability of Antipsychotic Drugs in Pediatric Patients: Data From a 1-Year Naturalistic Study. Front Psychiatry 2020; 11:152. [PMID: 32265749 PMCID: PMC7108128 DOI: 10.3389/fpsyt.2020.00152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/18/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Antipsychotic drugs (APs) are increasingly used to treat a variety of psychiatric disorders in children and adolescents. However, their safety and tolerability profiles, when used in a developmental age context, show different characteristics from the ones observed in adult patients. Treatment with APs in pediatric patients is often long-term. However, the tolerability data regarding these patients mostly derive from short-term studies. Methods: Starting from April 2017, for a 1-year period, patients between 4 and 18 years of age followed by five units of developmental age neuropsychiatry, who initiated a treatment with at least an AP (ATC class N05A) were included into the study. Patient-related data have been collected at baseline and regularly thereafter, as allowed by the clinical routine. Changes to continuous variables over time have been analyzed using a linear mixed model in subsamples of our population treated with risperidone or aripiprazole. Results: During the observation period, 158 patients were initially enrolled, but only 116 completed 12 months of therapy with an AP. Risperidone was the most used AP (n = 52) followed by aripiprazole (n = 44) and olanzapine (n = 7). For both the aripiprazole and risperidone groups, the mean body mass index (BMI) (P < 0.001 for both groups) and heart rate (P = 0.026 for aripiprazole group and P < 0.001 for the risperidone one) values significantly increased over time. The mean prolactin concentration value significantly increased over time only in the risperidone group (P = 0.04). Eighty-six patients experienced at least one adverse drug reaction (ADR), accounting for a total of 238 specific reactions, with the most frequent being weight gain (n = 34), increased serum prolactin levels (n = 21), hyperphagia (n = 20), and hypercholesterolemia (n = 14). Among these, only 24 ADRs were classifiable as serious. Conclusions: The results of this study confirm that risperidone and aripiprazole are relatively well-tolerated therapeutic options for the treatment of a variety of psychiatric disorders in pediatric patients. However, in findings such as statistically significant increments of BMI and heart rate mean values, the variations over time in prolactin levels observed with risperidone and the differences between the two drugs remark the necessity of systematic monitoring.
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Affiliation(s)
- Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria A Barbieri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenza Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmela Tata
- Childhood and Adolescence Neuropsychiatry, Azienda Sanitaria Provinciale 8, Syracuse, Italy
| | - Pia V Colucci
- Complex Operative Unit of Neurology for Mental Retardation, IRCCS Oasi Maria SS, Enna, Italy
| | - Francesca Vanadia
- Childhood Neuropsychiatry, Arnas Civico di Cristina Benfratelli, Palermo, Italy
| | - Flavia Drago
- Childhood Neuropsychiatry, Arnas Civico di Cristina Benfratelli, Palermo, Italy
| | - Carmelita Russo
- Childhood Neuropsychiatry, S. Marta and S. Venera Hospital, Azienda Sanitaria Provinciale 3, Catania, Italy
| | - Paola M Cutroneo
- Regional Pharmacovigilance Center, Siciliy, AOU Policlinico G. Martino, Messina, Italy
| | - Antonella Gagliano
- Child and Adolescent Neuropsychiatry, Department of Biomedical Sciences, University of Cagliari and "G. Brotzu" Hospital Trust, Cagliari, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Regional Pharmacovigilance Center, Siciliy, AOU Policlinico G. Martino, Messina, Italy
| | - Eva Germanò
- Department of Adulthood and Developmental Age Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
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Roessner V, Wolff N, Ehrlich S, Waltereit R. Need for a more developmental perspective: QTc prolongation under psychotropic medication. Eur Child Adolesc Psychiatry 2017; 26:871-873. [PMID: 28730428 DOI: 10.1007/s00787-017-1028-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Robert Waltereit
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Vo LC, Snyder C, McCracken C, McDougle CJ, McCracken JT, Aman MG, Tierney E, Arnold LE, Levi D, Kelleman M, Carroll D, Morrissey J, Vitiello B, Scahill L. No Apparent Cardiac Conduction Effects of Acute Treatment with Risperidone in Children with Autism Spectrum Disorder. J Child Adolesc Psychopharmacol 2016; 26:900-908. [PMID: 27726426 PMCID: PMC5178011 DOI: 10.1089/cap.2016.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Risperidone is approved for the treatment of serious behavioral problems in children with autism spectrum disorder (ASD). This study examined the effects of risperidone on cardiac conduction in children with ASD. METHODS Data were collected from an 8-week, five-site trial conducted by the Research Units on Pediatric Psychopharmacology Autism Network. Children (age 5-17 years) were randomly assigned to risperidone (n = 49) or placebo (n = 52) under double-blind conditions. Risperidone was superior to placebo in reducing serious behavioral problems. A standard 12-lead, electrocardiogram (ECG) was obtained in most subjects at screening and week 8. A pediatric electrophysiologist blind to treatment assignment reviewed all available ECGs for readability, abnormalities, and cardiac conduction parameters, including QTc. The electrophysiologist measurements were compared to machine readings. A second blinded electrophysiologist examined all available ECGs for abnormalities and a 20% random sample for QTc. RESULTS Of the 101 randomized subjects in the trial, complete pretreatment and week 8 data were available on 65 subjects (placebo n = 30; risperidone n = 35). The electrophysiologist did not identify any cardiac conduction adverse effects of risperidone and there was no difference in mean change on the QTc compared to placebo. The Bland-Altman plot showed a systematic bias in QTc measurements by the electrophysiologist and machine. Machine readings produced higher values than the electrophysiologist for shorter QTc intervals and machine scoring was lower than electrophysiologist readings for longer QTc values (p = 0.001). Two electrophysiologists had overall percent agreements of 82.9% (95% CI: 76.3 to 89.6) on qualitative assessment and 88.6% (95% CI: 79.3 to 98.0) on QTc interval. CONCLUSION Using conventional doses during acute treatment in children with ASD and serious behavioral problems, there was no difference in the mean change in QTc between risperidone and placebo. Compared to the electrophysiologist, the machine readings may miss elevated QTc measurements.
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Affiliation(s)
- Lan Chi Vo
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher Snyder
- Division of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Courtney McCracken
- Children's Hospital of Atlanta & Emory University School of Medicine, Atlanta, Georgia
| | - Christopher J. McDougle
- Harvard Medical School, Massachusetts General Hospital, Lurie Center for Autism, Boston, Massachusetts
| | - James T. McCracken
- Division of Child Psychiatry, University of California at Los Angeles, Los Angeles, California
| | | | | | | | - Daniel Levi
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | - Michael Kelleman
- Children's Hospital of Atlanta & Emory University School of Medicine, Atlanta, Georgia
| | - Deirdre Carroll
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - John Morrissey
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | | | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
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