COMPARATIVE RISK OF SUICIDAL IDEATION AND SELF-HARM AMONG PATIENTS WITH MAJOR DEPRESSIVE DISORDER TREATED WITH BREXPIPRAZOLE VERSUS OTHER ORAL ATYPICAL ANTIPSYCHOTICS: A PROPENSITY SCORE-MATCHED COHORT ANALYSIS
Author(s)
Marjan Zakeri, MD, PhD1, Wanlin Guo, MS1, Onur Baser, MA, MS, PhD2;
1Columbia Data Analytics, New York, NY, USA, 2City University of New York (CUNY), Graduate School of Public Health, New York, NY, USA
1Columbia Data Analytics, New York, NY, USA, 2City University of New York (CUNY), Graduate School of Public Health, New York, NY, USA
OBJECTIVES: Major depressive disorder (MDD) is a leading global contributor to disability and is closely linked to elevated risks of suicidal ideation and self-harm. Although atypical antipsychotics (AAPs) are commonly used as adjunctive therapies, their impact on suicidality remains insufficiently understood. This study aimed to examine suicidal ideation and self-harm among individuals diagnosed with MDD treated with brexpiprazole compared with other adjunctive AAPs, providing evidence to inform treatment safety and guide clinical decision-making.
METHODS: We conducted a retrospective cohort study using the Kythera Labs commercial claims database. Adults who initiated or re-initiated oral AAPs between January 1, 2021, and December 31, 2024, were included; the index date was the first AAP claim. Eligible patients had continuous enrollment for 24 months pre-index and 12 months post-index, ≥2 MDD diagnoses during baseline, and ≥30 days of overlapping antidepressant and AAP use within 90 days post-index. Patients with schizophrenia spectrum disorders, schizoaffective disorder, bipolar disorder, or post-traumatic stress disorder were excluded. Outcomes included suicidal ideation, self-harm, and a composite of both, identified via ICD-10-CM codes. Follow-up continued until death, disenrollment, or end of data; associations were estimated using a propensity score matching (PSM)-adjusted Cox model to derive hazard ratios (HRs) and 95% confidence intervals (CI).
RESULTS: After PSM, 10,336 patients were included in each cohort. Baseline characteristics were well balanced across groups (mean age ≈46 years; 60% female). Compared with other oral AAPs, brexpiprazole was associated with a significantly lower risk of the composite outcome of suicidal ideation or self-harm (HR=0.63; 95% CI: 0.53-0.75), self-harm alone (HR=0.58; 95% CI: 0.44-0.75), and suicidal ideation alone (HR=0.63; 95% CI: 0.51-0.78).
CONCLUSIONS: Brexpiprazole was associated with a reduced risk of suicidal ideation and self-harm compared with other AAPs. These findings offer important insights for clinicians treating MDD.
METHODS: We conducted a retrospective cohort study using the Kythera Labs commercial claims database. Adults who initiated or re-initiated oral AAPs between January 1, 2021, and December 31, 2024, were included; the index date was the first AAP claim. Eligible patients had continuous enrollment for 24 months pre-index and 12 months post-index, ≥2 MDD diagnoses during baseline, and ≥30 days of overlapping antidepressant and AAP use within 90 days post-index. Patients with schizophrenia spectrum disorders, schizoaffective disorder, bipolar disorder, or post-traumatic stress disorder were excluded. Outcomes included suicidal ideation, self-harm, and a composite of both, identified via ICD-10-CM codes. Follow-up continued until death, disenrollment, or end of data; associations were estimated using a propensity score matching (PSM)-adjusted Cox model to derive hazard ratios (HRs) and 95% confidence intervals (CI).
RESULTS: After PSM, 10,336 patients were included in each cohort. Baseline characteristics were well balanced across groups (mean age ≈46 years; 60% female). Compared with other oral AAPs, brexpiprazole was associated with a significantly lower risk of the composite outcome of suicidal ideation or self-harm (HR=0.63; 95% CI: 0.53-0.75), self-harm alone (HR=0.58; 95% CI: 0.44-0.75), and suicidal ideation alone (HR=0.63; 95% CI: 0.51-0.78).
CONCLUSIONS: Brexpiprazole was associated with a reduced risk of suicidal ideation and self-harm compared with other AAPs. These findings offer important insights for clinicians treating MDD.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO175
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy