Friday, April 6, 2018

Study Challenges Halting Antipsychotics in Stabilized Patients With Schizophrenia After Several Years

Many guidelines for treating patients with schizophrenia with antipsychotics recommend that after stabilization, antipsychotics should be continued for one to five years, and, if possible, longer exposure should be avoided. A study published today in AJP in Advance by Jari Tiihonen, M.D., Ph.D., of the Karolinska Institutet in Stockholm and colleagues suggests that the risk of treatment failure or relapse after discontinuation of antipsychotic medication does not decrease the longer a patient is stable on antipsychotics and that long-term antipsychotic treatment is associated with increased survival.

“We expected to observe that relapse risk decreases as [a] function of time, and if the decrease reached a plateau at a certain time point, that might help in estimating an optimal duration of antipsychotic treatment among stabilized patients,” Tiihonen and colleagues wrote. “To our surprise, however, the risk of relapse and treatment failure related to antipsychotic discontinuation increased at least through the first eight years, and no hint of any safe timing for discontinuation of treatment could be observed.”

The authors gathered nationwide data of all patients hospitalized for schizophrenia in Finland from 1972 to 2014. The researchers focused their analysis on data from patients with a first hospitalization for schizophrenia to study the risk of treatment failure (defined as psychiatric rehospitalization or death) after discontinuation of antipsychotics.

The lowest risk of rehospitalization or death was observed for patients who received antipsychotic treatment continuously (adjusted hazard ratio=1.00), followed by patients who discontinued antipsychotic use immediately after discharge from their first hospitalization (hazard ratio=1.63), within 1 year (hazard ratio=1.88), within 1 to 2 years (hazard ratio=2.12), within 2 to 5 years (hazard ratio=3.26), and after 5 years (a median of 7.9 years) (hazard ratio=7.28). (Tiihonen told Psychiatric News by email that while some patients stopped taking antipsychotics after more than eight years, there were too few to draw conclusions about this population’s risk of treatment failure.)

The risk of death was 174% to 214% higher among patients who never started taking antipsychotics or stopped using them within one year of their first hospitalization in comparison with patients who consistently took medications for up to 16.4 years.

While the authors noted the potential value of identifying a subgroup of patients with schizophrenia who could discontinue antipsychotics without relapsing, they pointed out that compared with patients who took antipsychotics, those who did not take the medications or discontinued them early were at a greater risk of death. “This suggests that, in general, there is no valid argument for stopping antipsychotic treatment in patients with a first episode of schizophrenia on the basis of concerns about their long-term physical well-being,” they wrote.

For related information, see the Psychiatric News article “Benefits of Maintenance Antipsychotics Outweigh Risks, International Panel Concludes.”

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