HIGHER QUETIAPINE DOSES MAY BE MORE EFFECTIVE

Frank Gianfrancesco, Ruey-hua Wang MS, and Jacqueline Pesa

Quetiapine, an atypical antipsychotic, is an effective and well tolerated agent for the treatment of schizophrenia and acute mania associated with bipolar disorder. However, broad dosage guidelines may have encouraged quetiapine initiation schedules that are too conservative to be optimally effective. This possibility was investigated in a recent study, “Relationship between initial quetiapine dose and effectiveness as reflected in subsequent mental health service use among patients with schizophrenia or bipolar disorder,” published in Value and Health, Volume 8, Issue 4. Using a large commercial claims database and controlling for patient differences, Gianfrancesco et al., of HECON Associates and AstraZeneca, found that patients initiated on higher doses of quetiapine had lower subsequent levels of mental health service use. Hospitalizations were mainly affected among schizophrenia patients while bipolar patients experienced reduced ambulatory services. Consistent with these findings, patients started on higher doses were also less likely to require later upward dose adjustments. Large numbers of both schizophrenia and bipolar patients were given quetiapine doses that were below the lowest recommended level (150 mg/d). While the study does not and cannot identify appropriate quetiapine dosage levels for commercially insured patients (who may be less severely ill), it does suggest that more aggressive dosing may be more effective.

Value in Health Volume 8 Issue 4 Page 471 - July 2005
ABSTRACT

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