Effectiveness of antipsychotics for managing agitated delirium in patients with advanced cancer: a secondary analysis of a multicenter prospective observational study in Japan (Phase-R)

TL;DR

This study found that olanzapine may be effective in managing agitation in delirium among advanced cancer patients.

Contribution

The study provides real-world evidence on the effectiveness of olanzapine for agitated delirium in advanced cancer patients.

Findings

Olanzapine showed a statistically significant adjusted odds ratio for improving agitation in delirium.

32% of patients with agitated delirium showed reduced agitation within 72 hours of pharmacotherapy.

Abstract

Delirium is a common and serious comorbidity in patients with advanced cancer, necessitating effective management. Nonetheless, effective drugs for managing agitated delirium in patients with advanced cancer remain unclear in real-world settings. Thus, the present study aimed to explore an effective pharmacotherapy for this condition.

We conducted a secondary analysis of a multicenter prospective observational study in Japan. The analysis included patients with advanced cancer who presented with agitated delirium and received pharmacotherapy. Agitation was defined as a score of the Richmond Agitation-Sedation Scale for palliative care (RASS-PAL) of ≥ 1. The outcome was defined as -2 ≤ RASS-PAL ≤ 0 at 72 h after the initiation of pharmacotherapy. Multiple propensity scores were quantified using a multinomial logistic regression model, and adjusted odds ratios (ORs) were calculated for haloperidol, chlorpromazine, olanzapine, quetiapine, and risperidone.

The analysis included 271 patients with agitated delirium, and 87 (32%) showed -2 ≤ RASS-PAL ≤ 0 on day 3. The propensity score-adjusted OR of olanzapine was statistically significant (OR, 2.91; 95% confidence interval, 1.12 to 7.80; P = 0.030).

The findings suggest that olanzapine may effectively improve delirium agitation in patients with advanced cancer.

The online version contains supplementary material available at 10.1007/s00520-024-08352-2.

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