Thailand: Quetiapine is Not Beneficial for Delirium Prevention in Hospitalized Older Medical Patients

A recent study in the journal BMC Geriatrics finds that quetiapine prophylaxis did not reduce delirium incidence in this population group.

Delirium is a common disorder among hospitalized older patients and results in increased mortality and morbidity. Delirium prevention is challenging in older patient care. The role of antipsychotics in the prevention of delirium is limited. Taweevat Assavapokee, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, and colleagues conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients.

For this purpose, the researchers conducted a randomized double-blind controlled trial at Ramathibodi Hospital, Bangkok. It enrolled 122 patients aged ≥65 years hospitalized in the internal medicine service. Patients were randomized to receive quetiapine 12.5 mg (n=57) or placebo (n=57) once daily at bedtime for a maximum 7-day duration.

Study Endpoints

• Primary endpoint: Delirium incidence.
• Secondary endpoints: Delirium duration, length of hospital stay, ICU admission, rehospitalization, and mortality within 30 and 90 days.

Key Findings

• The delirium incidence rates in the quetiapine and placebo groups were 14.0% and 8.8% (OR = 1.698), respectively.
• Other endpoints in the quetiapine and placebo groups were:
  • Median length of hospital stay: 6 days versus 5 days, respectively.
  • Delirium duration: 4 versus 3 days, respectively.
  • ICU admission: 3 (5.3%) patients from both groups.
  • Mortality in the quetiapine and placebo groups: 1 (1.8%) versus 2 (3.5%) at 30 days and 7 (12.3%) versus 9 (15.8%) at 90 days.
• There were no significant differences in other outcomes.
• None of the participants reported adverse events.

"Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients," wrote the authors. "The use of quetiapine to prevent delirium in this population group should not be recommended."

Reference

The study titled, "Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial," is published in the journal BMC Geriatrics.

DOI: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02160-7#Sec16