Abstract
Background Combination antipsychotics (CAs) are prescribed in schizophrenia despite limited evidence of efficacy. To explore the effect of switching from CA to monotherapy, we performed an exploratory analysis of the PROACTIVE (Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared with Injectables: Evaluating Efficacy) study data, in which 305 patients with schizophrenia and schizoaffective disorder were followed for 30 months after randomization to long-acting injectable (LAI) risperidone or second-generation oral antipsychotic (OA). Methods Patients who entered the PROACTIVE study on CA (n = 50), LAI (n = 20), or OA (n = 206) were compared in terms of time to relapse and clinical measures. Findings The OA group had significantly fewer hospitalizations than the CA group (P = 0.009) at baseline. In the CA group, 68% patients relapsed versus 53% in the LAI, and 52% in the OA groups. Although there was no significant difference in the relapse rate among groups on χ 2 test (χ 2 = 3.85, P = 0.146), the log-rank test showed a significant difference among the groups in time to first relapse (χ 2 = 6.81, P = 0.033), with significantly longer time to relapse in the OA group (mean, 562.8 days) than in the CA group (mean, 409.5; P = 0.011). The LAI group's mean time to first relapse (594 days) was not significantly different from the other groups. However, after adjusting for number of hospitalizations, group was no longer significant (hazard ratio, 1.541; P = 0.052). Implications Based on our exploratory analysis, taking antipsychotic combinations predicts earlier relapse and calls for additional treatment guidance in schizophrenia.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 595-599 |
| Number of pages | 5 |
| Journal | Journal of Clinical Psychopharmacology |
| Volume | 37 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 1 2017 |
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Keywords
- antipsychotic
- combinations
- prognosis
- relapse
- schizophrenia
ASJC Scopus subject areas
- Psychiatry and Mental health
- Pharmacology (medical)
Cite this
Combination Antipsychotic Therapies : An Analysis from a Longitudinal Pragmatic Trial. / Foster, Adriana Elena; Buckley, Peter F; Lauriello, John; Looney, Stephen Warwick; Schooler, Nina.
In: Journal of Clinical Psychopharmacology, Vol. 37, No. 5, 01.10.2017, p. 595-599.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Combination Antipsychotic Therapies
T2 - An Analysis from a Longitudinal Pragmatic Trial
AU - Foster, Adriana Elena
AU - Buckley, Peter F
AU - Lauriello, John
AU - Looney, Stephen Warwick
AU - Schooler, Nina
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background Combination antipsychotics (CAs) are prescribed in schizophrenia despite limited evidence of efficacy. To explore the effect of switching from CA to monotherapy, we performed an exploratory analysis of the PROACTIVE (Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared with Injectables: Evaluating Efficacy) study data, in which 305 patients with schizophrenia and schizoaffective disorder were followed for 30 months after randomization to long-acting injectable (LAI) risperidone or second-generation oral antipsychotic (OA). Methods Patients who entered the PROACTIVE study on CA (n = 50), LAI (n = 20), or OA (n = 206) were compared in terms of time to relapse and clinical measures. Findings The OA group had significantly fewer hospitalizations than the CA group (P = 0.009) at baseline. In the CA group, 68% patients relapsed versus 53% in the LAI, and 52% in the OA groups. Although there was no significant difference in the relapse rate among groups on χ 2 test (χ 2 = 3.85, P = 0.146), the log-rank test showed a significant difference among the groups in time to first relapse (χ 2 = 6.81, P = 0.033), with significantly longer time to relapse in the OA group (mean, 562.8 days) than in the CA group (mean, 409.5; P = 0.011). The LAI group's mean time to first relapse (594 days) was not significantly different from the other groups. However, after adjusting for number of hospitalizations, group was no longer significant (hazard ratio, 1.541; P = 0.052). Implications Based on our exploratory analysis, taking antipsychotic combinations predicts earlier relapse and calls for additional treatment guidance in schizophrenia.
AB - Background Combination antipsychotics (CAs) are prescribed in schizophrenia despite limited evidence of efficacy. To explore the effect of switching from CA to monotherapy, we performed an exploratory analysis of the PROACTIVE (Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared with Injectables: Evaluating Efficacy) study data, in which 305 patients with schizophrenia and schizoaffective disorder were followed for 30 months after randomization to long-acting injectable (LAI) risperidone or second-generation oral antipsychotic (OA). Methods Patients who entered the PROACTIVE study on CA (n = 50), LAI (n = 20), or OA (n = 206) were compared in terms of time to relapse and clinical measures. Findings The OA group had significantly fewer hospitalizations than the CA group (P = 0.009) at baseline. In the CA group, 68% patients relapsed versus 53% in the LAI, and 52% in the OA groups. Although there was no significant difference in the relapse rate among groups on χ 2 test (χ 2 = 3.85, P = 0.146), the log-rank test showed a significant difference among the groups in time to first relapse (χ 2 = 6.81, P = 0.033), with significantly longer time to relapse in the OA group (mean, 562.8 days) than in the CA group (mean, 409.5; P = 0.011). The LAI group's mean time to first relapse (594 days) was not significantly different from the other groups. However, after adjusting for number of hospitalizations, group was no longer significant (hazard ratio, 1.541; P = 0.052). Implications Based on our exploratory analysis, taking antipsychotic combinations predicts earlier relapse and calls for additional treatment guidance in schizophrenia.
KW - antipsychotic
KW - combinations
KW - prognosis
KW - relapse
KW - schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=85032437921&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032437921&partnerID=8YFLogxK
U2 - 10.1097/JCP.0000000000000766
DO - 10.1097/JCP.0000000000000766
M3 - Article
VL - 37
SP - 595
EP - 599
JO - Journal of Clinical Psychopharmacology
JF - Journal of Clinical Psychopharmacology
SN - 0271-0749
IS - 5
ER -