Costales B, Slama NE, Penfold RB, Nugent JR, Spalding SR, Sterling SA, Iturralde E. On- and Off-Label Atypical Antipsychotic Prescription Trends Across a Nine-Year Period Among Adolescents Pre- to Post-Covid-19.
Acad Pediatr 2024:S1876-2859(24)00072-X. [PMID:
38458489 DOI:
10.1016/j.acap.2024.03.003]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE
This study examined atypical antipsychotic prescribing by FDA approved-use (on-label) status for adolescents before and during the Covid-19 pandemic.
METHODS
Retrospective data were collected from electronic health records (EHRs) of adolescents aged 10-17 years in Kaiser Permanente Northern California. New outpatient atypical antipsychotic prescription orders during 2013-2021 were evaluated. Prescriptions were categorized as on-label if linked in EHRs to autism, psychosis, bipolar disorder, or Tourette's diagnoses; otherwise, they were potentially off-label (herein, off-label). Trend analysis of monthly prescribing rates assessed slope change at pandemic onset for the cohort and by sex and age groups.
RESULTS
Among 5,828 patients, 74.5% of new antipsychotic orders were off-label in 2021. Overall prescribing decreased significantly until early 2020 (slope = -0.045, p <.001) but then significantly increased through 2021 (post-March 2020 slope change = 0.211, p =.010). Off-label prescriptions increased at a similar rate during the Covid-19 time period, but on-label prescriptions did not change significantly. Males and younger adolescents (ages 10-14 years) showed significant decreases until early 2020, while females and older adolescents (ages 15-17 years) did not. Females and younger adolescents exhibited significant increases in overall and off-label prescribing rates following pandemic onset; older adolescents exhibited increases in overall prescriptions while males had no detectable changes.
CONCLUSIONS
Antipsychotic prescribing declined slightly but then increased significantly following Covid-19 onset for overall and off-label prescriptions. Pandemic onset differentially impacted antipsychotic prescribing by sex and age, with overall and off-label prescribing driven by increases among female and younger adolescents.
WHAT'S NEW
Within a large, diverse, integrated healthcare delivery system, Covid-19 pandemic onset coincided with a rebound in antipsychotic prescribing after a previous decline among adolescents; this change was driven by potentially off-label prescriptions, particularly among females and adolescents aged 10-14 years.
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