ABSTRACT
Choroidal neovascularization (CNV) is a rare condition in children but poses a substantial threat to vision. Anti-vascular endothelial growth factor (anti-VEGF) therapy is commonly used in the pediatric population to treat retinopathy of prematurity. However, the use of anti-VEGF is less common for childhood CNV due to the rarity of CNV in the pediatric population. We report the case of a 10-year-old male presenting with an idiopathic choroidal neovascular membrane. Following a relapse of subretinal fluid after photodynamic therapy, anti-VEGF (bevacizumab) was injected and resulted in remission of the neovascular membrane and improved visual outcome. Further studies are required to elucidate the long-term outcomes associated with the use of anti-VEGF in pediatric patients.
ABSTRACT
BACKGROUND AND OBJECTIVE: Antipsychotic medication use has steadily increased in Canada, with an expansion in the profile of users and the diagnoses for which they are used. The use of antipsychotics is associated with a number of adverse effects for which routine monitoring is recommended. The objectives of this study were to determine the most common diagnoses associated with antipsychotic use in children in Alberta, Canada and the proportion who receive recommended laboratory tests for adverse effects. METHODS: Data on dispensed antipsychotics, diagnoses, prescribers, and laboratory testing were obtained from provincial data sources. To assess the frequency of metabolic and hormonal laboratory baseline and/or follow-up testing, the sample was divided into an antipsychotic-naïve cohort and an antipsychotic non-naïve cohort. RESULTS: In 2014, 6916 children were dispensed at least one second- or third-generation antipsychotic. The most frequently dispensed antipsychotics were risperidone (3908 children), quetiapine (2140 children), and aripiprazole (1302 children). The majority of children prescribed risperidone were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or conduct disorder. Quetiapine was mainly prescribed for neurotic disorder or depression, while aripiprazole was prescribed most frequently for conduct disorder or neurotic disorders. Among antipsychotic-naïve patients, 17% had at least one laboratory test done at baseline, and 35% had at least one laboratory test done at follow-up. In the non-naïve patients, 42% had at least one follow-up laboratory test. Lipid and glucose testing were done in less than 5% of the naïve cohort at baseline, and in less than 15% at follow-up. In the non-naïve cohort, less than 22% received lipid or glucose testing during the year 2014. CONCLUSIONS: The majority of antipsychotic use in children in Alberta is off-label and associated with disruptive behavior disorders, depression, and anxiety disorders. The vast majority of children prescribed antipsychotic medications do not undergo recommended laboratory tests.
Subject(s)
Antipsychotic Agents/therapeutic use , Child Behavior Disorders/drug therapy , Child Behavior Disorders/epidemiology , Drug Prescriptions/standards , Neurodevelopmental Disorders/drug therapy , Neurodevelopmental Disorders/epidemiology , Population Surveillance , Adolescent , Alberta/epidemiology , Antipsychotic Agents/adverse effects , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Population Surveillance/methods , Quetiapine Fumarate/adverse effects , Quetiapine Fumarate/therapeutic use , Risperidone/adverse effects , Risperidone/therapeutic useABSTRACT
OBJECTIVE: The objective of this study was to evaluate trends in prescribing of the second-generation antipsychotic medication quetiapine to adults in the province of Alberta from 2008 to 2013 through examination of dispensed prescriptions, and diagnoses associated with users of quetiapine in 2013. METHODS: We analysed administrative data from Alberta Health; the Alberta Pharmaceutical Information Network (PIN) Dispenses health data set, the Practitioner Payments (Fee-For-Service claims) health data set and the Population Registry health data set. These data sets allowed us to identify discrete quetiapine recipients for each calendar year from 2008 to 2013. To evaluate diagnoses associated with users of quetiapine, we evaluated diagnostic codes used by physicians in billings claims in 2013. RESULTS: Quetiapine use increased over the 6-year time period studied. In 2008, there were 16,087 unique quetiapine recipients in Alberta (7.2 per 1000). By 2013, there were 35,314 unique quetiapine recipients (13.3 per 1000). Use by women was higher than men at all time points. Depression was most common diagnosis associated with quetiapine recipients, which was present in 56% of users of quetiapine. Other common diagnoses associated with quetiapine use included neurotic disorders, bipolar disorder and sleep disturbances. CONCLUSIONS: The current study of quetiapine use in the province of Alberta provides confirmatory data of the increasing use of quetiapine for the treatment of depression and anxiety disorders. Safe and rational prescribing practices must be encouraged in light of the modest advantages of quetiapine over no treatment as an adjunctive treatment of major depression, and the known harms of this medication.
