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As many as 30% of patients with schizophrenia are treated with a combination of antipsychotics, although the practice is controversial because of its lack of evidence of tolerability, safety, and efficacy, wrote Jari Tiihonen, M.D., Ph.D., of the Karolinska Institutet in Sweden and colleagues.
In this study on the long-term use of antipsychotic polypharmacy in schizophrenia, researchers examined seven monotherapies and 22 antipsychotic combinations, excluding polypharmacy periods shorter than 90 days.
Researchers analyzed data on all Finnish patients with schizophrenia treated in an inpatient setting from 1972 to 2014, and the 62,250 patients were followed for a median of 14 years, with researchers pulling data on their dispensation of antipsychotic medication. The primary outcomes studied were the number of psychiatric rehospitalizations, with hospitalizations due to physical illnesses and deaths serving as secondary outcomes.
During that time 58% of participants were readmitted for psychiatric inpatient care.
The study findings include the following:
- Nearly 60% of participants used antipsychotic polypharmacy for at least 90 days. This practice was associated with a 13% lower risk of psychiatric rehospitalization compared with monotherapy.
- The treatment associated with the best outcome in terms of psychiatric or all-cause hospitalization was clozapine plus aripiprazole. Patients taking this combination had a 14% lower risk of psychiatric rehospitalization than those taking clozapine alone, which was the monotherapy associated with the best outcome.
- The advantage of the clozapine plus aripiprazole combination was greater for patients with first-episode schizophrenia, who were 23% less likely to be rehospitalized than other patients with first-episode schizophrenia.
- Among the 29 therapies examined, patients taking quetiapine monotherapy had highest risk of psychiatric rehospitalization, but adding on any another antipsychotic resulted in a better outcome.
The researchers concluded that certain types of polypharmacy may be beneficial in the treatment of schizophrenia. “Although the results do not indicate that all types of polypharmacy are beneficial, the current treatment guidelines should modify their categorical recommendations discouraging all antipsychotic polypharmacy in the maintenance treatment of schizophrenia,” they wrote.
For more information, see the Psychiatric Services article “Addressing Barriers to Clozapine Underutilization: A National Effort” and the Psychiatric News article “Clozapine, LAI Antipsychotics Found Best at Preventing Relapse.”
(Image: iStock/noipornpan)
