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
N1 - Funding Information:
Data used in the preparation of this article were obtained from the limited access datasets distributed from the NIH-supported “Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared with Injectables: Evaluating Efficacy” (PROACTIVE). This is a multi-site, clinical trial of persons with Schizophrenia comparing effectiveness of randomly assigned medication treatment. The study was supported by NIMH grant #s: U01MH070007-01,U01MH070023,U01MH070011,U01 MH070009,U01MH070008,U01MH070017,U01MH070010, U01 MH070016, U01 MH070012. The ClinicalTrials.gov identifier is NCT00330863. This manuscript reflects the views of the authors and may not reflect the opinions or views of the PROACTIVE Study Investigators or the NIH.
Funding Information:
Adriana Foster has nothing to disclose. Peter Buckley has received grant and research support from Ameritox, Auspex Pharmaceuticals, Inc, Alkermes, Inc, Avanir Pharmaceuticals, Inc, Otsuka Pharmaceuticals, and National Institutes of Mental Health and is a consultant for National Institutes of Mental Health. John Lauriello participated in clinical research at a site on a study headed and paid by Columbia University, sponsored by Sunovion, as well as in a clinical research site for a study headed and paid by Florida Atlantic University, sponsored by Otsuka, and is a member of the Event Monitoring Board for Janssen (services funded through a contract with the University of Missouri), Event Monitoring Board for Alkermes (services funded through a contract with the University of Missouri), and Advisory Panel for Sunovion, Janssen, Otsuka, Reckitt Benckiser, and Teva. Stephen Looney has nothing to disclose. Nina Schooler has received grant support from Genentech and Otsuka; she has served on advisory boards or provided consultation to Alkermes, Allergan, Forum, Roche, and Sunovion.
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
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U2 - 10.1097/JCP.0000000000000766
DO - 10.1097/JCP.0000000000000766
M3 - Article
C2 - 28806390
AN - SCOPUS:85032437921
VL - 37
SP - 595
EP - 599
JO - Journal of Clinical Psychopharmacology
JF - Journal of Clinical Psychopharmacology
SN - 0271-0749
IS - 5
ER -