LAUSR

Montastruc et al. [1] reported an annual prevalence of use of antipsychotic drugs (APs) of 2.0% in the general population and 3.6% among those ≥ 65 years old in France. The use of AP in the elderly is of concern. Systematic reviews by regulatory agencies [2, 3] have concluded that the use of APs for the treatment of aggression and psychotic symptoms in elderly patients with dementia increases mortality by twofold. In 2008, the European national regulatory agencies recommended limiting the use of APs to patients not responding to other interventions during the shortest possible period and to reconsider their prescription at every follow-up visit, with close patient follow-up [4]. In spite of these recommendations, in Catalonia between 2008 and 2013, the consumption by the general population of AP increased from 9.8 to 11.9 defined daily doses (DDD) per 1000 inhabitants and per day [5]. We examined the use of APs among the elderly in the Catalan Health Service (CHS) prescription claims database. The CHS provides public-funded universal healthcare coverage to the entire population (7.5 million inhabitants), including all prescription drugs. The electronic prescription database contains complete records of all prescriptions from all general practices and outpatient speciality clinics claimed from pharmacies, with data on patients’ age, sex, the dispensed medicines, and the date of the dispensing. It does not contain data on indications and clinical diagnoses [6]. All APs (group N05A of the ATC Classification) were considered. The prevalence of use of APs was estimated as the percentage of individuals ≥ 70 years old in the general population who had at least one recorded prescription of an AP between January 1 and December 31 2015, for the whole population and by age and sex strata. During the 1-year period, 89,431 individuals ≥ 70 years old (60,329 female; 67.5%) received at least one prescription of an AP (21.3% first-generation [FGAP] APs and 78.7% second-generation [SGAP] APs). This corresponds to a prevalence of 9.12% of those ≥ 70 years old (female, 10.42%; male, 7.25%). Each exposed patient received a mean of 7.5 months of treatment. Exposure to SGAP was longer than to FGAP (8.2 vs 4.4 monthly units per patient per year). The prevalence of use increased with age, reaching 20.91% among those ≥ 90 years old (Fig. 1). The prevalence figures we report are threeto tenfold those reported in recent studies from other countries (between 0.8 and 3.57%) [1, 7–11]. In a comparative study of electronic databases in Europe, the annual rates of use in those 70– 74 years old varied between 0.48 and 2.13% [12]. On the other hand, the long mean duration of use, of 7.5 months during the 12-month period, indicates that the majority of patients do not receive short-term treatment and contrasts with the EMA and FDA recommendations. One of the few industry-independent randomised clinical trials in the symptomatic treatment of aggression and