Real-world studies generating hypothesis for new treatment options

Utilization of so called real-world data on effectiveness and safety of medications is increasingly popular. By combining data from dispensed medications, hospital admissions and diagnosis, and causes of death, the safety and effectiveness of medication use can be evaluated on a population-level. Real-world studies have presented their value: i) when investigating certain subpopulations which are excluded from clinical trials due to various reasons; ii). for detecting medication safety issues that have not been observed in randomized clinical trials, especially concerning long-term risks; iii) revealing new insights on effectiveness of medications. Recent published examples with Sweden registers include borderline personality disorder and (met)amphetamine use disorder which both lack indicated pharmacotherapies for their treatment.

Most patients with borderline personality disorder receive psychopharmacological treatment although clinical guidelines lack consensus on the role of pharmacotherapy. From Swedish nationwide registers, we identified all patients diagnosed with borderline personality disorder and followed their treatment outcomes with various medications. All major psychopharmacotherapies were associated with an increased risk of psychiatric hospitalization or suicide attempts/ death, including antipsychotics, antidepressants and benzodiazepines. However, treatment with ADHD medications was associated with decreased risk of psychiatric hospitalization, all-cause hospitalization/ death and suicide attempt/ death. The use mainly consisted of stimulant medication.  



There are no medications approved for the treatment of amphetamine dependence. By utilizing Swedish registers, we investigated treatment outcomes among patients diagnosed with amphetamine use disorder when using vs. not using specific psychopharmacotherapies. Most promising results were found to be for a stimulant medication which was associated with decreased risk of hospitalization due to substance use, all-cause hospitalization/ death and all-cause and overdose-related mortality.



Both studies challenge current clinical guidelines and conceptualisation of substance use disorders psychopathology as chronic diseases.