Effectiveness of antipsychotic drugs in schizophrenia: a 10-year retrospective study in a Korean tertiary hospital

Abstract

Extensive research has been carried out on the comparative effectiveness of antipsychotic medications. Most studies, however, have been performed in Western countries. The purpose of this study was to compare the effectiveness, indicated by time to any-cause discontinuation, of antipsychotic drugs in a large number of patients with schizophrenia in South Korea. We identified 1458 patients with schizophrenia or schizophreniform disorder who were treated with antipsychotic medications using a clinical data warehouse at the Seoul National University Hospital between March 2005 and February 2014. Kaplan–Meier survival analyses were used to estimate the time to discontinuation of antipsychotic drugs. We compared the survival curves of different antipsychotics using log-rank tests. Overall, the median time to discontinuation for any cause was 133 days (95% CI, 126–147). The longest time to discontinuation was observed for clozapine, followed by aripiprazole, paliperidone, olanzapine, amisulpride, risperidone, quetiapine, ziprasidone, and haloperidol. Specifically, clozapine was significantly different from all other antipsychotic drugs (all p < 0.001). Aripiprazole also had a significantly longer time to discontinuation than amisulpride (p = 0.001), risperidone (p < 0.001), quetiapine (p < 0.001), ziprasidone (p < 0.001), and haloperidol (p < 0.001). In Asian patients with schizophrenia, clozapine was the most effective antipsychotic in terms of time to discontinuation, followed by aripiprazole. This study extends the findings of previous effectiveness studies from Western populations and suggests the need to develop guidelines for the pharmacotherapy of schizophrenia tailored to Asian individuals.

Clozapine resistant schizophrenia: Newer avenues of management

“…Unlike the influence of gender, ethnicity does not appear to have any impact on treatment response obtained with clozapine[ 115 , 130 ]. On the other hand, there are ethnic differences in pharmacokinetic profiles of clozapine[ 122 ].…”

Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019

“…In addition, a study conducted on ADRs in the psychiatric department of a tertiary care hospital in India reported that olanzapine, risperidone, and haloperidol were most commonly associated with adverse effects (Patel et al, 2015). This discrepancy could be attributed to differences in local prescription patterns and traditions across countries rather than differences in the incidence of ADRs of antipsychotic drugs (Dong et al, 2019; Oh et al, 2020). In Korea, for example, quetiapine has been widely used as it is preferred over other antipsychotics for alleviating sleep problems, as an adjuvant therapy for depression (Kim et al, 2019), and a treatment for delirium in intensive care units (Jung and Lee, 2019).…”

“…However, there is little information regarding the characteristics of antipsychotic adverse effects among the Asian population. Because of the differences in the genetic and non-genetic mechanisms that influence pharmacokinetics and epidemiology, ethnicity causes significant differences in drug response and side effects (Chaudhry et al, 2008; Chong et al, 2003; Oh et al, 2020). Thus, a large-scale investigation within the Asian population is warranted.…”

Comparison of prediction methods for treatment continuation of antipsychotics in children and adolescents with schizophrenia

“…Second, patients might discontinue or change the antipsychotic treatment regimen because of worsening of symptoms or the onset of other mental health disorders, not because they showed a poor response to their first-line antipsychotic agent. To overcome this limitation, several events indicating the worsening of psychiatric symptoms were included to identify poor treatment results 12 28. Third, it was impossible to include all predictors that might improve the accuracy of the prediction model, such as the type of schizophrenia, disease severity and residential area, due to the lack of data.…”