Comparative Prevalence of Suicidal Ideation and Self-Harm History: Rexulti vs. Other Oral Atypical Antipsychotics
Author(s)
Onur Baser, MS, PhD1, Nehir Yapar2, Erdem Baser, MS, PhD3, Munira Mohamed, MPH4, Alexandra Passarelli, MPH4, Shuangrui Chen, MS4, Yuanqing Lu, MS4, Katarzyna Rodchenko, MA, MPH4.
1Graduate School of Public Health, City University of New York (CUNY), New York, NY, USA, 2Analyst, Columbia Data Analytics, New York, NY, USA, 3Mergen Medical Research, Ankara, Turkey, 4Columbia Data Analytics, New York, NY, USA.
1Graduate School of Public Health, City University of New York (CUNY), New York, NY, USA, 2Analyst, Columbia Data Analytics, New York, NY, USA, 3Mergen Medical Research, Ankara, Turkey, 4Columbia Data Analytics, New York, NY, USA.
OBJECTIVES: Major depressive disorder (MDD) is a leading cause of disability worldwide and strongly associated with suicidal ideation/self-harm. Atypical antipsychotics (AAPs) are commonly used as adjunctive treatments for MDD, though their impact on suicidality remains under investigation. This study compared the prevalence of suicidal ideation or personal history of self-harm among patients using Rexulti (brexpiprazole) vs other AAPs.
METHODS: This retrospective cohort study utilized the Kythera Labs commercial database population from 01JAN2019-31MAY2025. Patients were included if they initiated or re-initiated oral AAPs from 01JAN2021-31MAY2024 (index date = first AAP pharmacy claim date), following a ≥90-day washout period with no AAP use. Eligible patients had ≥2 MDD diagnoses during the 2-year baseline, continuous health plan enrollment for 2 years pre- and 1-year post-index date, and ≥30 days of overlapping antidepressant and AAP use within 90 days post-index date to confirm adjunctive therapy. Patients with serious mental illness or who switched AAPs during follow-up were excluded. Propensity score matching (PSM) was used to compare outcomes between patients treated with brexpiprazole vs other oral AAPs.
RESULTS: Total 8,617 commercially-insured patients with brexpiprazole use were compared to 115,388 patients with oral AAP use. Patients with brexpiprazole use were younger on average (mean age 46.96 vs 49.61 years; p<.0001), more likely to be female (74.70% vs 68.37%; p<.0001), and had a lower mean Charlson Comorbidity Index score (0.77 vs 0.96; p<.0001). After PSM, the prevalence of suicidal ideation/self-harm was significantly lower in brexpiprazole users vs other AAP users (1.24% vs 3.38%, p<.0001).
CONCLUSIONS: Results show that brexpiprazole was associated with significantly lower rates of suicidal ideation/self-harm in patients with MDD vs other AAPs. Additional studies are needed to understand the underlying mechanisms and validate these findings across broader populations. These results offer important guidance for clinicians selecting antipsychotic treatments for patients with MDD.
METHODS: This retrospective cohort study utilized the Kythera Labs commercial database population from 01JAN2019-31MAY2025. Patients were included if they initiated or re-initiated oral AAPs from 01JAN2021-31MAY2024 (index date = first AAP pharmacy claim date), following a ≥90-day washout period with no AAP use. Eligible patients had ≥2 MDD diagnoses during the 2-year baseline, continuous health plan enrollment for 2 years pre- and 1-year post-index date, and ≥30 days of overlapping antidepressant and AAP use within 90 days post-index date to confirm adjunctive therapy. Patients with serious mental illness or who switched AAPs during follow-up were excluded. Propensity score matching (PSM) was used to compare outcomes between patients treated with brexpiprazole vs other oral AAPs.
RESULTS: Total 8,617 commercially-insured patients with brexpiprazole use were compared to 115,388 patients with oral AAP use. Patients with brexpiprazole use were younger on average (mean age 46.96 vs 49.61 years; p<.0001), more likely to be female (74.70% vs 68.37%; p<.0001), and had a lower mean Charlson Comorbidity Index score (0.77 vs 0.96; p<.0001). After PSM, the prevalence of suicidal ideation/self-harm was significantly lower in brexpiprazole users vs other AAP users (1.24% vs 3.38%, p<.0001).
CONCLUSIONS: Results show that brexpiprazole was associated with significantly lower rates of suicidal ideation/self-harm in patients with MDD vs other AAPs. Additional studies are needed to understand the underlying mechanisms and validate these findings across broader populations. These results offer important guidance for clinicians selecting antipsychotic treatments for patients with MDD.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH51
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Injury & Trauma, Mental Health (including addition)