Long-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial

Abstract

Food and Health Bureau, Research Grants Council of Hong Kong, and AstraZeneca.

To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial

“…Yet, the first study with a long follow-up time by Wunderink and colleagues reported better outcomes after 7 years with early discontinuation in terms of symptomatic and functional remission compared to maintenance treatment [11]. The recent study conducted by Hui and colleagues [13] could not replicate this finding, as they found a higher risk of poor clinical outcome in the discontinuation group compared to the maintenance group when evaluating long-term clinical outcome at 10 years. This underlines the importance of additional long-term cohorts to systematically investigate the effects of the two strategies on different outcomes.…”

“…The follow-up of the Wunderink [12] study demonstrated that, after 7 years, patients in the original discontinuation condition experienced twice the functional recovery rate (40.4%) in comparison to those on maintenance treatment (17.6%) [11]. However, the recent study by Hui and colleagues [13] also investigating the effects of early discontinuation on long-term clinical outcome at 10 years was in strong contrast with the Wunderink [12] finding, as they reported a higher risk of poor clinical outcome in the discontinuation group compared to the maintenance group (respectively 39% versus 21%). Poor clinical outcome was defined by persistent positive symptoms of psychosis, treatment-resistant psychosis, or death by suicide.…”

“…Moreover, after 7 years, dose reduction/discontinuation patients showed higher functional recovery rates versus patients following maintenance treatment. Recently, Hui et al [13] reported on their 10-year follow-up study. Notably, they found higher rates of poor long-term clinical outcome in the discontinuation group (39%) compared to the maintenance treatment group (21%).…”

“…Taken together, previous trials comparing dose reduction/discontinuation versus treatment maintenance have indicated that continuation of antipsychotic medication reduces the risk of psychotic relapse in remitted FEP patients. However, harmful effects may also be associated with maintenance treatment [27] and two studies with long-term follow-up have shown contradictory findings [12,13]. This makes it difficult to determine best practices based on the current literature.…”

Polypharmacy in schizophrenia

“…9,10 Antipsychotic monotherapy is the evidence-based and recommended treatment regimen for both acute symptom exacerbation 4 and for maintenance treatment to prevent future symptom relapse. 11,12 There is no evidence to support monotherapy with pharmaceutical compounds other than antipsychotics. A simplified version of a treatment guideline for use of antipsychotics in schizophrenia is shown in Figure 2.…”