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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