(ASPOT23) Trends in Use of Antipsychotics in Germany 2014–2023: A Nationwide Population-based Study

Background: Use of antipsychotics (AP) among children and adolescents in Germany has continued to increase over the last decade. Contemporary data of the use of AP across all age groups are lacking, however.

Objectives: We aimed to provide an update on trends in AP use across all age groups in Germany between 2014 and 2023.

Methods: We analysed anonymised claims data from the German Institute for Drug Use Evaluation, containing information on dispensed AP in an outpatient care setting of approximately 87% of the German population. We selected the ATC code N05A (antipsychotics) except lithium (N05AN01), analysed the quantity of packages dispensed in community pharmacies as packages per 1,000 statutory health-insured persons per year (PIY) and stratified by age group and type of AP medication (typical vs. atypical).

Results: The overarching AP use increased from 2014 to 2023 +9% (156.5 to 170.2 PIY). While the typical AP use fell -12% (70.9 to 62.3 PIY), the atypical (second-generation) AP use rose +26% (85.6 to 107.9 PIY). The time trend of AP use from 2014 to 2023 in different age groups exhibited differences. The largest increase in AP use were in the age groups “15-29 years old” (from 53.1 to 67.4 PIY, +27%) and “60-74 years old “(from 174.6 to 212.9 PIY, + 22 %).
Trend analysis for AP by active ingredients with highest use in 2023 showed that quetiapine use increased +53% (28.2 to 43.2 PIY), risperidone use increased +13% (24.2 to 27.3 PIY), but melperone use decreased -5% (22.3 to 21.32 PIY). An analysis of the age groups for the year 2023 showed that AP use rise gradually with age, and particularly strongly from the age of 80: 75–79 years: 271.4 PIY, 80–84 years: 407.1 PIY, 85–89 years: 641.8 PIY, ≥90 years: 1065.1 PIY. Up to the age of 84, atypical AP were used more frequently than typical; from the age of 85, typical AP were used more frequently.

Conclusions: The analyses show three important issues that require further study:

• The overall increasing AP use in Germany
• The increasing AP use in the younger adults group (15–29 years)
• The high AP use in patients >80 years