Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007-2017)

Benjamin Rolland; Faustine Dalon; Noémie Gauthier; Mikaïl Nourredine; Marjorie Bérard; Louise Carton; Georges Brousse; Pierre-Michel Llorca; Flore Jacoud; Eric Van Ganse; Manon Belhassen

doi:10.3389/fpsyt.2022.1021780

Antipsychotic prescribing practices in real-life (APPREAL study): Findings from the French National Healthcare System Database (2007-2017)

Front Psychiatry. 2022 Oct 31:13:1021780. doi: 10.3389/fpsyt.2022.1021780. eCollection 2022.

Authors

Benjamin Rolland^{1

2}, Faustine Dalon³, Noémie Gauthier⁴, Mikaïl Nourredine^{5

6}, Marjorie Bérard³, Louise Carton⁷, Georges Brousse⁸, Pierre-Michel Llorca⁸, Flore Jacoud³, Eric Van Ganse^{3

9

10}, Manon Belhassen³

Affiliations

¹ Centre Hospitalier Le Vinatier, Hospices Civils de Lyon, Academic Department of Addiction Medicine (SUAL), Bron, France.
² Université Claude Bernard Lyon 1, Lyon, France.
³ PELyon, Lyon, France.
⁴ Saint-Cyr au Mont d'Or Hospital, Hospital Pharmacy, Saint-Cyr-au Mont-d'Or Psychiatric Hospital, Saint-Cyr-au Mont-d'Or, France.
⁵ Hospices Civils de Lyon, Pharmacotoxicology Laboratory, Department of Clinical Research and Epidemiology, Lyon, France.
⁶ Faculté de Médecine Lyon Sud, Lyon 1 University, Lyon, France.
⁷ CHU Lille, Department of Pharmacology, Inserm, Lille Neuroscience and Cognition, UMR-S1172, Université de Lille, Lille, France.
⁸ CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, University Clermont Auvergne, Clermont-Ferrand, France.
⁹ Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
¹⁰ Claude Bernard Lyon 1 University, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.

Abstract

Background: Antipsychotics are used in a large variety of psychiatric and neurological disorders; investigating their use in real life is important to understand national prescribing practices, as well as to determine the levels of patient adherence.

Methods: Using a 1/97e random sample (General Sample of Beneficiaries, EGB) of the French health insurance reimbursement database, we conducted a historical cohort study on the 2007-2017 period. The aim was to describe the sociodemographic characteristics of patients, the types of antipsychotics dispensed, the types of prescribers, the mean doses and average durations of treatment, the co-dispensed medications, and the levels of adherence to treatment. To exclude punctual uses of antipsychotics, we selected only patients with a continuous dispensing of the same antipsychotic over at least 3 months.

Results: In total, 13,799 subjects (1.66% of the EGB sample) were included (56.0% females; mean age 55.8 ± 19.4 years). Risperidone (19.3%), cyamemazine (18.7%), olanzapine (11.9%), tiapride (8.8%), and haloperidol (7.5%) were the five most prescribed antipsychotics. 44.9% of prescriptions were written by general practitioners, 34.1% by hospital practitioners, and 18.4% by private-practice psychiatrists. On average, the mean dispensed doses were relatively low, but the variation range was large. Long-acting forms were used in 5.4% of the sample, and clozapine in 1.3%. 34.2% of patients received more than one antipsychotic, and almost 15% were prescribed at least three concomitant antipsychotics. Paliperidone and clozapine were associated with the highest levels of adherence, and risperidone and haloperidol with the lowest ones.

Conclusion: An important heterogeneity of antipsychotic prescribing practices was observed in France. The rate of use of long-acting antipsychotics was low, whereas multiple antipsychotic prescriptions were frequent.

Keywords: France; adherence–compliance–persistance; antipsychotics; pharmacoepidemiogy; polymedication; prescribing.