Atypical antipsychotic agents are associated with a longer time to all-cause medication discontinuation than older typical antipsychotics
Two studies presented at a recent international
psychiatric congress indicate that use of an atypical antipsychotic
by patients with schizophrenia is associated with longer time to
all-cause medication discontinuation and better outcome than use
of a typical antipsychotic. Data for 1029 patients from the 3-year
naturalistic U.S. Schizophrenia Care and Assessment Program was
analyzed: Atypical antipsychotics had a lower discontinuation rate
than typicals regardless of potency level, with correlations consistent
across gender and age. Another study pooled data from six longer-term
(at least 24 weeks) double-blind, randomized studies to assess treatment
duration and outcome. Longer trial participation was significantly
associated with greater clinical improvements in symptoms and quality
of life as measured by three common instruments. The pooled trials
used various atypical antipsychotics but all used haloperidol as
the typical agent.
Full Text: Two studies presented at a recent
international psychiatric congress indicate that use of an atypical
antipsychotic by patients with schizophrenia is associated with
a longer time to all-cause medication discontinuation and better
outcome than use of an older, typical antipsychotic.
"When patients with schizophrenia stop
taking antipsychotic medication as prescribed, they are at greater
risk of relapse and hospitalization," said Jeff Swanson, PhD,
an investigator in one of the studies. "One study showed patients
who adhered to recommended treatment consistently over time tend
to experience reduction in symptoms, and improved functional outcomes.
Other studies showed significant differences among antipsychotics
with regard to patient adherence, which should be considered when
choosing the most appropriate treatment for patients with schizophrenia."
The Schizophrenia Care and Assessment Program
(US-SCAP) was a 3-year non- randomized, multi-site, naturalistic
study conducted in the United States. Time to all-cause discontinuation
was evaluated from data for 1028 patients (1666 treatment episodes)
taking antipsychotics. Of 1666 treatment episodes, 1132 were with
atypicals and 534 were with typical antipsychotics. Patients who
were initiated on either atypical antipsychotics (olanzapine, clozapine,
risperidone, quetiapine, ziprasidone) or typical antipsychotics
(low, medium or high-potency) were compared on time to all-cause
medication discontinuation.
When measuring time to all-cause discontinuation,
atypical antipsychotics were found to have a lower discontinuation
rate than typical antipsychotics, regardless of potency level. This
was measured by the number of days of continuous treatment up to
the first time medication was discontinued during the first year
of treatment, provided discontinuation was for more than 30 days.
The associations were consistent across gender, age, and ethnicity.
When compared with perphenazine, only clozapine
and olanzapine patients had a significantly longer time to medication
discontinuation. The mean time to discontinuation differed by 84
days for clozapine and 48 days for olanzapine. Clozapine, olanzapine,
and risperidone had longer time to discontinuation versus haloperidol
combined with prophylactic anticholinergic agents. The mean time
to discontinuation was 64 days higher for risperidone, 87 days higher
for olanzapine, and 123 days for clozapine.
Another study pooled data from six longer-term
(greater than or equal to 24 weeks) double-blind, randomized studies
to assess impact of duration of treatment with patient outcomes.
The analysis studied patients with schizophrenia taking olanzapine,
haloperidol, risperidone, quetiapine, or ziprasidone.
Longer trial participation was significantly
associated with greater clinical improvements as measured by Positive
and Negative Syndrome Scale (PANSS scores; r=-0.42 to -0.52, p <
0.001), Medical Outcomes Study 36-item Short Form Health Survey
component summaries and all subscales (r=0.08 to 0.28, p < 0.005),
and the Quality of Life Scale total and all subscales (r=0.19 to
0.31, p < 0.0001).
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