Mortality during US FDA clinical trials in patients with diabetes, hypertension, depression and schizophrenia

Objectives: To evaluate the relationship between the mortality rates associated with psychiatric conditions like depression and schizophrenia compared with chronic medical conditions like hypertension and diabetes. Methods: Examined clinical trial safety data from New Drug Approval programmes reviewed by the US Food and Drug Administration and calculated all-cause and suicide/non-suicide mortality rates per 100,000 patient-exposure-years (PEY) for seven diabetes, 12 hypertension, 11 depression, and nine schizophrenia programmes (126,151 patients, 63,106.3 PEY). Results: Depression (894.8 +/- 201.2) and schizophrenia (935.3 +/- 214.6) had significantly higher all-cause mortality rates than diabetes (462.8 +/- 70.8) and hypertension (448.4 +/- 123.1). Psychiatric conditions had 1.9-2.1x the medical conditions' mortality (p < 0.001). Non-suicide mortality rates for depression (506.2 +/- 151.3), schizophrenia (550.9 +/- 164.7), diabetes (457.2 +/- 70.4) and hypertension (430.8 +/- 120.6) were comparable. Only antidiabetics showed a signal for all-cause mortality (reduction of 37%, p = 0.008). Conclusions: Depression and schizophrenia trial patients had comparable (if not higher) all-cause mortality rates as older populations in diabetes and hypertension trials, even when excluding suicides. While generalizability of the rates themselves is limited, this study can adequately estimate the relational mortality among these conditions because of the high internal consistency of clinical trials. Potential signals for mortality reduction with active treatment should be considered for all investigational medications for chronic conditions with increased mortality, including psychotropics.