Thursday, March 23, 2023

Antipsychotic Polypharmacy at Higher Doses Does Not Increase Hospitalization Risk, Study Finds

Patients with schizophrenia appear to be at a lower risk of hospitalization for physical health issues when taking high doses of two or more antipsychotic medications concurrently (polypharmacy) than when taking just one antipsychotic medication (monotherapy) at the same dose, according to a study published yesterday in AJP in Advance.

“When patients were treated with high-dose antipsychotic monotherapy …, they had approximately a 20% higher risk of severe cardiovascular outcomes leading to hospitalization compared with periods when the same patients were treated with corresponding high-dose combination therapy,” wrote Heidi Taipale, Ph.D., of the University of Eastern Finland and colleagues.

The study included data collected from 61,889 patients diagnosed with schizophrenia who were alive on January 1, 1996, and had received inpatient care, as documented in Finland’s nationwide Hospital Discharge register. Taipale and colleagues tracked these patients up until December 31, 2017, or until they died, whichever occurred first. They specifically compared the patients’ nonpsychiatric and cardiovascular hospitalizations during periods when they were receiving antipsychotic polypharmacy versus monotherapy. The researchers also compared differences in outcomes according to antipsychotic exposure by further dividing the groups according to the following defined daily doses (DDDs): <0.4, 0.4 to <0.6, 0.6 to <0.9, 0.9 to <1.1, 1.1 to <1.4, 1.4 to <1.6, and ≥1.6. (A DDD of 1.0 reflects the average dose of a medication prescribed to an adult, according to the World Health Organization.)

Here are some of the findings they reported:

  • About 46.4% of patients had used high-dose (≥1.6 DDDs/day) monotherapy and 52.6% had used high-dose polypharmacy.
  • During the follow-up period (about 15 years), 45,013 patients experienced nonpsychiatric hospitalization and 13,893 experienced cardiovascular hospitalization.
  • The risk of nonpsychiatric hospitalization was 13% lower when patients were taking high-dose antipsychotic polypharmacy compared with when taking high-dose monotherapy.
  • The risk of cardiovascular hospitalization was 18% lower when patients were taking high-dose antipsychotic polypharmacy compared with when taking high-dose monotherapy.

“Our results on antipsychotic use in a large nationwide cohort over a long follow-up show that antipsychotic polypharmacy is associated with lower risk of hospitalizations for physical health issues than monotherapy in the maintenance treatment of schizophrenia when high total dosage is assessed,” the authors concluded. “The current recommendations of treatment guidelines categorically encouraging use of monotherapy instead of polypharmacy are not based on evidence and should take a more agnostic approach to this issue.”

For related information, see the Psychiatric News article “Two Studies Analyze Add-On Treatments for Schizophrenia.”

(Image: iStock/Hiraman)

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