Antipsychotic use among persons with schizophrenia in Sweden and Finland, trends and differences

Taipale, Heidi; Puranen, Arto; Mittendorfer‐Rutz, Ellenor; Tiihonen, Jari; Tanskanen, Antti; Červenka, Simon; Lähteenvuo, Markku

doi:10.1080/08039488.2020.1854853

Cited by 17 publications

(25 citation statements)

References 26 publications

(32 reference statements)

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“…It is worth mentioning one limitation of our review, namely SGAs developed more recently, such as paliperidone, lurasidone, sertindole, asenapine and brexpiprazole, were not included in our study. These SGA trials were only included if the original antipsychotics determined by Chaves and Seeman (2006)-risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, which are among the most commonly prescribed SGAs [43][44][45]-were also being tested. A recent systematic review and network meta-analysis conducted by Huhn et al (2019) [46] encompassed 402 RCTs to compare the efficacy of 32 oral antipsychotics.…”

Section: Discussionmentioning

confidence: 99%

Sex Selection Bias in Schizophrenia Antipsychotic Trials—An Update Systematic Review

Fonseca

Machado

Luersen

et al. 2021

Women

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The lack of female participation in antipsychotic trials for schizophrenia poses an important issue regarding its applicability, with direct and real-life repercussions to clinical practice. Here, our aim is to systematically review the sampling sex bias among randomized clinical trials (RCTs) of second-generation antipsychotics—namely risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole—as an update to a previous 2005 review. We searched MEDLINE and the Cochrane database for studies published through 7 September 2020 that assessed adult samples of at least 50 subjects with a diagnosis of schizophrenia, schizophrenia spectrum disorder, or broad psychosis, in order to investigate the percentage of women recruited and associated factors. Our review included 148 RCTs, published from 1993 to 2020, encompassing 43,961 subjects. Overall, the mean proportion of women was 34%, but only 17 trials included 50% or more females. Younger samples, studies conducted in North America, pharmaceutical funding and presence of specific exclusion criteria for women (i.e., pregnancy, breast-feeding or lack of reliable contraceptive) were associated with a lower prevalence of women in the trials. Considering the possible different effects of antipsychotics in both sexes, and our lack of knowledge on the subject due to sampling bias, it is imperative to expand actions aimed at bridging this gap.

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Section: Discussionmentioning

confidence: 99%

Sex Selection Bias in Schizophrenia Antipsychotic Trials—An Update Systematic Review

Fonseca

Machado

Luersen

et al. 2021

Women

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“… We did not consider individuals using clozapine or first-generation antipsychotics because the former is not a first-line treatment but reserved for treatment resistance (here defined as clozapine or electroconvulsive therapy treatment, reported ever before follow-up), and the latter are only rarely used in real-world clinical practice in Finland and Sweden. Continuous medication use was derived using the PRE2DUP method from dispensed prescriptions. …”

Section: Methodsmentioning

confidence: 99%

Representation and Outcomes of Individuals With Schizophrenia Seen in Everyday Practice Who Are Ineligible for Randomized Clinical Trials

et al. 2022

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“…Total oral antipsychotic prescriptions (excluding clozapine) greatly outnumbered LAIs (73% vs 15%) despite evidence that LAI formulations dramatically reduce relapse rate in schizophrenia (Subotnik et al, 2015;Tiihonen et al, 2011). These levels of LAI prescription are lower than in the United Kingdom where just under 30% are dispensed an LAI (Patel et al, 2014) but similar to those in Scandinavia (Taipale et al, 2020) where between 13% and 20% received an SGA or FGA LAI from 2006 to 2016. In South East Asia (Tang et al, 2020), LAI use ranges from 0% to 44%.…”

Section: Main Findingsmentioning

confidence: 96%

“…practice guidelines (Galletly et al, 2016) concerning the management of schizophrenia recommend that SGAs be used in preference to FGAs, which is the case here. The only other similar extant national data for schizophrenia come from Sweden and Finland (Taipale et al, 2020), where in 2016 oral SGAs were used at 65% and 57%, respectively, whereas oral FGA usage there was 17-18%.…”

Section: Main Findingsmentioning

confidence: 99%

Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study

Taylor

Dangelo-Kemp²,

Liu

et al. 2021

Aust N Z J Psychiatry

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Objectives: To evaluate the utilisation and persistence of antipsychotics for the treatment of schizophrenia in Australia. Methods: A retrospective study using the Australian Pharmaceutical Benefits Scheme database of a representative 10% sample. All adults with schizophrenia who were dispensed three or more supplies of oral (including clozapine) or long-acting injectable antipsychotics between 1 June 2015 and 31 May 2020 were included. Persistence time in treatment was evaluated using survival analysis and Cox hazard ratios. Results: In all, 26,847 adults with schizophrenia were studied. Oral second-generation antipsychotics were more frequently dispensed than the other antipsychotic groups studied. Median treatment persistence times were 18.3 months for second-generation antipsychotic long-acting injectables, 10.7 months for oral second-generation antipsychotics and were significantly lower for both formulations of first-generation antipsychotics at 5.2 months (long-acting injectables) and 3.7 months (oral). The median persistence time for clozapine was significantly longer than all other antipsychotics groups. Conclusions: Oral second-generation antipsychotics and second-generation antipsychotic long-acting injectables accounted for over 75% and 13% of all antipsychotics in Australia, respectively. Concerns over medication adherence and subsequent relapse have not translated into increased long-acting injectable usage despite their significantly longer persistence. Clozapine, the single most ‘persistent’ antipsychotic, was only used in 9% of people, although up to a third of all cases are likely to be treatment-resistant. Our data suggest clinicians should give consideration to the earlier use of second-generation antipsychotic long-acting injectables and clozapine, to ameliorate prognosis in schizophrenia.

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Antipsychotic use among persons with schizophrenia in Sweden and Finland, trends and differences

Cited by 17 publications

References 26 publications

Sex Selection Bias in Schizophrenia Antipsychotic Trials—An Update Systematic Review

Sex Selection Bias in Schizophrenia Antipsychotic Trials—An Update Systematic Review

Representation and Outcomes of Individuals With Schizophrenia Seen in Everyday Practice Who Are Ineligible for Randomized Clinical Trials

Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study

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