Post authorization safety study comparing quetiapine to risperidone and olanzapine

E. M. Heintjes, J. A. Overbeek, F. J. Penning-van Beest, G. Brobert, R. M. Herings

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OBJECTIVES: To compare rates of specific adverse outcomes between patients starting quetiapine, olanzapine, or risperidone use in the Netherlands. METHODS: Observational study using the PHARMO Database Network, including patients starting quetiapine (4658), olanzapine (5856), or risperidone (7229) in 2000-2009, comparing rates of all-cause mortality, failed suicide attempts, extrapyrimidal symptoms (EPS), diabetes mellitus (DM), hypothyroidism, and acute myocardial infarction (AMI). KEY FINDINGS: Median follow-up until discontinuation/end of follow-up was 0.6 years. Prescribed doses were generally lower than the approved defined daily doses, especially for quetiapine. Quetiapine was significantly associated with lower EPS rates (HR 0.18; 95% CI 0.13-0.24), but higher failed suicide attempt rates (HR 2.07; 95% CI 1.35-3.16) compared to risperidone. Quetiapine was significantly associated with lower EPS rates (HR 0.59; 95% CI 0.42-0.84) and DM rates (HR 0.66; 95% CI 0.44-0.97) compared to olanzapine. Rates for all-cause mortality, hypothyroidism, and stroke were similar between groups. AMI events were too infrequent to draw conclusions. CONCLUSIONS: Quetiapine was associated with lower EPS, but higher failed suicide attempt rates compared to risperidone. Quetiapine was associated with lower EPS and DM rates compared to olanzapine. The results should be interpreted with caution because of possible channelling and residual confounding. Copyright (c) 2016 John Wiley & Sons, Ltd.
Original languageEnglish
Pages (from-to)304-312
Number of pages9
JournalHuman psychopharmacology
Issue number4
Publication statusPublished - 2016


  • Adult Aged Antipsychotic Agents/*adverse effects Basal Ganglia Diseases/chemically induced/mortality Benzodiazepines/*adverse effects Cohort Studies Female Follow-Up Studies Humans Male Middle Aged Mortality/trends Netherlands/epidemiology Olanzapine Product Surveillance, Postmarketing/*methods Quetiapine Fumarate/*adverse effects Retrospective Studies Risperidone/*adverse effects Schizophrenia/*drug therapy/mortality *antipsychotic drugs *observational study *olanzapine *quetiapine *risperidone *safety

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