Antipsychotic treatment and risk of discontinuation and hospitalization in first-episode schizophrenia: a nationwide population-based study

2021 ◽  
pp. 1-8
Author(s):  
Sung Woo Joo ◽  
Harin Kim ◽  
Young Tak Jo ◽  
Young Jae Choi ◽  
Soojin Ahn ◽  
...  
Keyword(s):  
Real World ◽  
Randomized Clinical Trials ◽  
Cox Regression ◽  
Psychiatric Hospitalization ◽  
Treatment Discontinuation ◽  
Current Evidence ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Typical Antipsychotic ◽  
First Episode Schizophrenia

Abstract Background Current evidence on antipsychotic treatment and risk of psychiatric hospitalization in first-episode schizophrenia (FES) is largely based on the findings from randomized clinical trials (RCTs). However, the generalization of the findings to real-world patients is limited due to inherent caveats of the RCT. We aimed to investigate the treatment discontinuation and risk of psychiatric hospitalization using a nationwide population database. Methods The Health Insurance Review Agency database in South Korea was obtained, and the observation period started from 1 January 2009 to 31 December 2016. We defined the maintenance period as the period from 6-month after the diagnosis of schizophrenia, which is utilized for the main results. For a total of 44 396 patients with FES, a within-individual Cox regression model was used to compare the risk of the treatment discontinuation and psychiatric hospitalization. Results In group comparison, a long-acting injectable (LAI) antipsychotic group was associated with the lowest risk of the treatment discontinuation (0.64, 0.55–0.75) and psychiatric hospitalization (0.29, 0.22–0.38) in comparison with a typical antipsychotic group and no use, respectively. Among individual antipsychotics, the lowest risk of the treatment discontinuation was observed in LAI paliperidone (0.46, 0.37–0.66) compared to olanzapine. Clozapine was found to be the most effective antipsychotic in lowering the risk of psychiatric hospitalization as monotherapy compared to no use (0.23, 0.18–0.31). Conclusions In real-world patients with FES, LAI paliperidone and clozapine were associated with low treatment discontinuation and better effectiveness in lowering the risk of psychiatric hospitalization.

scholarly journals Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone

2020 ◽  
Vol 23 (4) ◽  
pp. 217-229 ◽  
Author(s):  
Marcos Gómez-Revuelta ◽  
José María Pelayo-Terán ◽  
María Juncal-Ruiz ◽  
Javier Vázquez-Bourgon ◽  
Paula Suárez-Pinilla ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Dropout Rate ◽  
Treatment Discontinuation ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Open Label ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Treatment Groups

Abstract Background Different effectiveness profiles among antipsychotics may be a key point to optimize treatment in patients suffering a first episode of psychosis to impact on long-term outcome. The aim of this study is to compare the clinical effectiveness of olanzapine, risperidone, haloperidol, aripiprazole, ziprasidone, and quetiapine in the treatment of first episode of psychosis at 3-year follow-up. Method From February 2001 to January 2011, 2 phases of a prospective, randomized, open-label study were undertaken. A total of 376 first-episode drug-naïve patients were randomly assigned to olanzapine (n = 55), risperidone (n = 63), haloperidol (n = 56), aripiprazole (n = 78), ziprasidone (n = 62), or quetiapine (n = 62) and followed up for 3 years. The primary effectiveness measure was all cause of treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted in the analysis for clinical efficacy. Results The overall dropout rate at 3 years reached 20.75%. Treatment discontinuation rates were significantly different among treatment groups (olanzapine = 69.09, risperidone = 71.43, aripiprazole = 73.08%, ziprasidone = 79.03%, haloperidol = 89.28%, and quetiapine = 95.53%) (χ2 = 79.86; P = .000). Statistically significant differences in terms of lack of efficacy, adherence, and tolerability were observed among treatment groups along the 3-year follow-up, determining significant differences in time to all-cause discontinuation (log-rank = 92.240; P = .000). Significant differences between treatments were found in the categories of sleepiness/sedation, increased sleep duration, akinesia, weight gain, ejaculatory dysfunction, extrapyramidal-symptoms, and amenorrhea. Conclusions Olanzapine, risperidone, and aripiprazole presented advantages for the first-line treatment of first episode of psychosis in terms of effectiveness. Identifying different discontinuation patterns may contribute to optimize treatment selection after first episode of psychosis. ClinicalTrials.gov Identifier: NCT02526030 https://clinicaltrials.gov/show/NCT02526030

Clinical Outcome After Antipsychotic Treatment Discontinuation in Functionally Recovered First-Episode Nonaffective Psychosis Individuals

2015 ◽  
Vol 77 (04) ◽  
pp. 492-500 ◽  
Author(s):  
Jacqueline Mayoral-van Son ◽  
Victor Ortiz-Garcia de la Foz ◽  
Obdulia Martinez-Garcia ◽  
Teresa Moreno ◽  
Maria Parrilla-Escobar ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Treatment Discontinuation ◽  
First Episode ◽  
Antipsychotic Treatment

A Comparison of Long-Term Outcome in First-Episode Schizophrenia Following Treatment With Risperidone or a Typical Antipsychotic

2001 ◽  
Vol 62 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Ashok K. Malla ◽  
Ross M. G. Norman ◽  
Derek J. Scholten ◽  
Sandra Zirul ◽  
Vinod Kotteda
Keyword(s):  
First Episode ◽  
Typical Antipsychotic ◽  
Term Outcome ◽  
Long Term Outcome ◽  
First Episode Schizophrenia

scholarly journals Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

BJPsych Open ◽  
2016 ◽  
Vol 2 (5) ◽  
pp. 323-329 ◽  
Author(s):  
Richard Whale ◽  
Michael Harris ◽  
Gail Kavanagh ◽  
Vijitha Wickramasinghe ◽  
Christopher I. Jones ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Initiation ◽  
Cox Regression ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Cox Regression Analysis ◽  
Episode Psychosis ◽  
Case Files ◽  
One Year ◽  
Risk Of Treatment

BackgroundOne year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).AimsTo investigate the effectiveness of commonly used antipsychotic medications in FEP.MethodA retrospective cohort study of naturalistic treatment of patients (N = 460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.ResultsRisk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.ConclusionsEffectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.

scholarly journals Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial

2013 ◽  
Vol 16 (5) ◽  
pp. 987-995 ◽  
Author(s):  
W. Wolfgang Fleischhacker ◽  
Cynthia O. Siu ◽  
Robert Bodén ◽  
Elizabeth Pappadopulos ◽  
Onur N. Karayal ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Prevalence Rate ◽  
Individual Risk ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Groups ◽  
Individual Risk Factors ◽  
First Episode Schizophrenia

Abstract Available data on antipsychotic-induced metabolic risks are often constrained by potential confounding effects due to prior antipsychotic treatment. In this study, we assessed the baseline prevalence of metabolic abnormalities and changes following treatment with five commonly-used antipsychotic drugs (haloperidol, amisulpride, olanzapine, quetiapine or ziprasidone) in first-episode, partially antipsychotic-naive patients with schizophrenia in the European first-episode schizophrenia trial (EUFEST). Overall baseline prevalence of metabolic syndrome (MetS) was 6.0%, with similar rates observed in the antipsychotic-naive patients (5.7%, 9/157) and in the other patients with only a brief prior exposure to antipsychotics (6.1%, 20/326). These results are consistent with the MetS prevalence rate estimated in a general population of similar age. Examination of individual risk factors showed 58.5% of subjects had one or more elevated metabolic risks at baseline: 28.5% demonstrated suboptimal HDL; 24.2% hypertension; 17.7% hypertriglyceridemia; 8.2% abdominal obesity; 7.3% hyperglycaemia. Increase in body weight (kg/month) occurred in patients treated with haloperidol (0.62 s.e. 0.11), amisulpride (0.76 s.e. 0.08), olanzapine (0.98 s.e. 0.07) and quetiapine (0.58 s.e. 0.09), which was significantly greater than that in the ziprasidone group (0.18 s.e. 0.10). The incidence rate of new diabetes cases over a 52-wk follow-up period was 0.82% (4/488). More patients experienced worsening rather than improvement of hypertriglyceridemia or hyperglycaemia in all treatment groups. Our findings suggest that in first-episode, partially antipsychotic-naive patients, the baseline prevalence rate of MetS appears to be no higher than that in the general population, but serious underlying individual risk factors nevertheless existed.

scholarly journals Sex Difference in Cognitive Response to Antipsychotic Treatment in First Episode Schizophrenia

2007 ◽  
Vol 33 (2) ◽  
pp. 290-297 ◽  
Author(s):  
Leah H Rubin ◽  
Gretchen L Haas ◽  
Matcheri S Keshavan ◽  
John A Sweeney ◽  
Pauline M Maki
Keyword(s):  
Sex Difference ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Cognitive Response ◽  
First Episode Schizophrenia
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