Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia

Tiihonen, Jari; Mittendorfer‐Rutz, Ellenor; Majak, Maila; Mehtälä, Juha; Hoti, Fabian; Jedenius, Erik; Enkusson, Dana; Levál, Amy; Sermon, Jan; Tanskanen, Antti; Taipale, Heidi

doi:10.1001/jamapsychiatry.2017.1322

Cited by 504 publications

(463 citation statements)

References 24 publications

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“…Effectiveness results following the approval of this drug have been consistent. Data from the Swedish national registry using within‐patient analyses show that periods of clozapine treatment were 42% less likely to be associated with hospitalization compared with periods of olanzapine treatment in individuals with schizophrenia (hazard ratio [HR] = 0.58, 95% CI = 0.53‐0.63) . These results have been replicated with claims data in the United States, which found a 22% reduction in the risk of hospitalization during periods following clozapine initiation (HR = 0.78, 95% CI = 0.69–0.88) .…”

Section: State Of the Artmentioning

confidence: 83%

How and when to use clozapine

Rubio

Kane

2019

Acta Psychiatr Scand

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Objective Clozapine is the only approved strategy for treatment‐resistant schizophrenia, although it is highly underutilized. We aim to generate practical and actionable evidence‐based recommendations for the use of this drug considering prescription barriers. Method Narrative review. Results A consistent body of evidence supports the efficacy of clozapine reducing morbidity and mortality in schizophrenia. The main obstacles to its use are the lack of experience by prescribers and perceived treatment burden. Systematic screening of eligibility, utilization of available resources for consultation, developing a professional network with other stakeholders, as well as optimizing how clozapine is presented to patients is discussed. Furthermore, specific evidence‐based recommendations for initiation, maintenance, and safety monitoring with clozapine are provided. Conclusion Clozapine prescription is one of the areas in psychiatry with the greatest mismatch between efficacy and utilization in clinical practice. Although multiple barriers to the use of clozapine exist, some of these may be overcome by updates of routine clinical practice.

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Section: State Of the Artmentioning

confidence: 83%

How and when to use clozapine

Rubio

Kane

2019

Acta Psychiatr Scand

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“…This was replicated in a Swedish cohort including all phases of illness, following patients for a median of 6.9 years. Six of the top eight antipsychotic monotherapies that were significantly superior regarding hospitalization risk compared to not receiving any antipsychotic (hazard ratios, HRs=0.51‐0.64) were LAIs (with the two oral antipsychotics being clozapine and olanzapine).…”

Section: Efficacy Effectiveness and Tolerabilitymentioning

confidence: 99%

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

2018

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The long-term benefit-to-risk ratio of sustained antipsychotic treatment for schizophrenia has recently been questioned. In this paper, we critically examine the literature on the long-term efficacy and effectiveness of this treatment. We also review the evidence on the undesired effects, the impact on physical morbidity and mortality, as well as the neurobiological correlates of chronic exposure to antipsychotics. Finally, we summarize factors that affect the risk-benefit ratio. There is consistent evidence supporting the efficacy of antipsychotics in the short term and mid term following stabilization of acute psychotic symptoms. There is insufficient evidence supporting the notion that this effect changes in the long term. Most, but not all, of the long-term cohort studies find a decrease in efficacy during chronic treatment with antipsychotics. However, these results are inconclusive, given the extensive risk of bias, including increasing non-adherence. On the other hand, long-term studies based on national registries, which have lower risk of bias, find an advantage in terms of effectiveness during sustained antipsychotic treatment. Sustained antipsychotic treatment has been also consistently associated with lower mortality in people with schizophrenia compared to no antipsychotic treatment. Nevertheless, chronic antipsychotic use is associated with metabolic disturbance and tardive dyskinesia. The latter is the clearest undesired clinical consequence of brain functioning as a potential result of chronic antipsychotic exposure, likely from dopaminergic hypersensitivity, without otherwise clear evidence of other irreversible neurobiological changes. Adjunctive psychosocial interventions seem critical for achieving recovery. However, overall, the current literature does not support the safe reduction of antipsychotic dosages by 50% or more in stabilized individuals receiving adjunctive psychosocial interventions. In conclusion, the critical appraisal of the literature indicates that, although chronic antipsychotic use can be associated with undesirable neurologic and metabolic side effects, the evidence supporting its long-term efficacy and effectiveness, including impact on life expectancy, outweighs the evidence against this practice, overall indicating a favorable benefit-to-risk ratio. However, the finding that a minority of individuals diagnosed initially with schizophrenia appear to be relapse free for long periods, despite absence of sustained antipsychotic treatment, calls for further research on patient-level predictors of positive outcomes in people with an initial psychotic presentation.

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“…The authors conducted a cohort study of all the patients with a diagnosis of schizophrenia between 1 July 2006 and 31 December 2013 in Sweden, studying separately the cohort of patients who received a new diagnosis of schizophrenia during the study period 5. The intervention was the prescribed pharmacological treatment, obtained from the National drug registry.…”

Section: Methods Of the Studymentioning

confidence: 99%

Clozapine and long-acting injectable antipsychotics reduce hospitalisation and treatment failure risk in patients with schizophrenia

Rubio

Correll

2018

Evid Based Mental Health

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Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia

Cited by 504 publications

References 24 publications

How and when to use clozapine

How and when to use clozapine

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

Clozapine and long-acting injectable antipsychotics reduce hospitalisation and treatment failure risk in patients with schizophrenia

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Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia

Cited by 504 publications

References 24 publications

How and when to use clozapine

How and when to use clozapine

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

Clozapine and long-acting injectable antipsychotics reduce hospitalisation and treatment failure risk in patients with schizophrenia

Contact Info

Product

Resources

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Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia