REAL-WORLD TREATMENT PATTERNS IN MANIC/MIXED BIPOLAR I DISORDER: A US RETROSPECTIVE COHORT STUDY

Introduction

Bipolar I disorder (BP-I) is a chronic psychiatric condition characterized by alternating manic and depressive symptoms, often with mixed features. The management of BP-I is complex due to symptom heterogeneity and the need for long-term pharmacotherapy. Real-world evidence on treatment patterns for manic/mixed episodes remains limited. This study described demographic and clinical characteristics and treatment patterns among US patients with manic symptoms/mixed features of BP-I.

Methods

This retrospective cohort study using IQVIA Pharmetrics claims data was conducted from January 2019 to July 2025. Adults aged 18 to 65 years with ≥1 inpatient or ≥2 outpatient claims with ICD-10 diagnoses of manic/mixed BP-I during July 2019 to July 2025 were included. Baseline was 6 months before index diagnosis; follow-up continued until death, disenrollment, or study end. Descriptive statistics summarized demographics and treatment patterns, including monotherapy and combination therapy.

Results

Among 22,026 patients (mean age: 39.5 years; 62% female), 36% received medication at baseline and 64% during follow-up. The most prescribed medications were lamotrigine (30%; mean duration: 406 days), quetiapine (29%; 334 days), aripiprazole (27%; 254 days), valproate (14%; 303 days), and lithium (10%; 353 days). Twenty percent of patients received combination therapy, most commonly lamotrigine + antipsychotic (11%), valproate + antipsychotic (5%), and lithium + antipsychotic (4%). Patterns were heterogeneous, reflecting clinical complexity.

Conclusions

Findings highlight the variability in BP-I management and underscore the need for individualized strategies. Future research should examine drivers of treatment selection and outcomes in routine care.