Complex polypharmacy in bipolar disorder

Side effect burden, adherence, and response predictors

Vicki C. Fung, Lindsay N. Overhage, Louisa G. Sylvia, Noreen A. Reilly-Harrington, Masoud Kamali, Keming Gao, Richard C. Shelton, Terence A. Ketter, William V Bobo, Michael E. Thase, Joseph R. Calabrese, Mauricio Tohen, Thilo Deckersbach, Andrew A. Nierenberg

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP. Methods: We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks). Results: 43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. Limitations: There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error. Conclusions: BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.

Original languageEnglish (US)
Pages (from-to)17-22
Number of pages6
JournalJournal of Affective Disorders
Volume257
DOIs
StatePublished - Oct 1 2019

Fingerprint

Polypharmacy
Bipolar Disorder
Medication Adherence
Anxiety Disorders
Self Report

Keywords

  • Bipolar disorder
  • Complex polypharmacy
  • Medication adherence
  • Polypharmacy

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Fung, V. C., Overhage, L. N., Sylvia, L. G., Reilly-Harrington, N. A., Kamali, M., Gao, K., ... Nierenberg, A. A. (2019). Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors. Journal of Affective Disorders, 257, 17-22. https://doi.org/10.1016/j.jad.2019.06.050

Complex polypharmacy in bipolar disorder : Side effect burden, adherence, and response predictors. / Fung, Vicki C.; Overhage, Lindsay N.; Sylvia, Louisa G.; Reilly-Harrington, Noreen A.; Kamali, Masoud; Gao, Keming; Shelton, Richard C.; Ketter, Terence A.; Bobo, William V; Thase, Michael E.; Calabrese, Joseph R.; Tohen, Mauricio; Deckersbach, Thilo; Nierenberg, Andrew A.

In: Journal of Affective Disorders, Vol. 257, 01.10.2019, p. 17-22.

Research output: Contribution to journalArticle

Fung, VC, Overhage, LN, Sylvia, LG, Reilly-Harrington, NA, Kamali, M, Gao, K, Shelton, RC, Ketter, TA, Bobo, WV, Thase, ME, Calabrese, JR, Tohen, M, Deckersbach, T & Nierenberg, AA 2019, 'Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors', Journal of Affective Disorders, vol. 257, pp. 17-22. https://doi.org/10.1016/j.jad.2019.06.050
Fung, Vicki C. ; Overhage, Lindsay N. ; Sylvia, Louisa G. ; Reilly-Harrington, Noreen A. ; Kamali, Masoud ; Gao, Keming ; Shelton, Richard C. ; Ketter, Terence A. ; Bobo, William V ; Thase, Michael E. ; Calabrese, Joseph R. ; Tohen, Mauricio ; Deckersbach, Thilo ; Nierenberg, Andrew A. / Complex polypharmacy in bipolar disorder : Side effect burden, adherence, and response predictors. In: Journal of Affective Disorders. 2019 ; Vol. 257. pp. 17-22.
@article{2e51a38501a3482b9c360af7693e71df,
title = "Complex polypharmacy in bipolar disorder: Side effect burden, adherence, and response predictors",
abstract = "Background: Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP. Methods: We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30{\%} of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks). Results: 43{\%} of patients had any CP and 25{\%} had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95{\%} CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16{\%} achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. Limitations: There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error. Conclusions: BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.",
keywords = "Bipolar disorder, Complex polypharmacy, Medication adherence, Polypharmacy",
author = "Fung, {Vicki C.} and Overhage, {Lindsay N.} and Sylvia, {Louisa G.} and Reilly-Harrington, {Noreen A.} and Masoud Kamali and Keming Gao and Shelton, {Richard C.} and Ketter, {Terence A.} and Bobo, {William V} and Thase, {Michael E.} and Calabrese, {Joseph R.} and Mauricio Tohen and Thilo Deckersbach and Nierenberg, {Andrew A.}",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.jad.2019.06.050",
language = "English (US)",
volume = "257",
pages = "17--22",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

TY - JOUR

T1 - Complex polypharmacy in bipolar disorder

T2 - Side effect burden, adherence, and response predictors

AU - Fung, Vicki C.

AU - Overhage, Lindsay N.

AU - Sylvia, Louisa G.

AU - Reilly-Harrington, Noreen A.

AU - Kamali, Masoud

AU - Gao, Keming

AU - Shelton, Richard C.

AU - Ketter, Terence A.

AU - Bobo, William V

AU - Thase, Michael E.

AU - Calabrese, Joseph R.

AU - Tohen, Mauricio

AU - Deckersbach, Thilo

AU - Nierenberg, Andrew A.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP. Methods: We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks). Results: 43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. Limitations: There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error. Conclusions: BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.

AB - Background: Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP. Methods: We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks). Results: 43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. Limitations: There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error. Conclusions: BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.

KW - Bipolar disorder

KW - Complex polypharmacy

KW - Medication adherence

KW - Polypharmacy

UR - http://www.scopus.com/inward/record.url?scp=85068501535&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068501535&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2019.06.050

DO - 10.1016/j.jad.2019.06.050

M3 - Article

VL - 257

SP - 17

EP - 22

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -