Relapse according to antipsychotic treatment in schizophrenic patients: a propensity-adjusted analysis

Abstract

ObjectiveTo compare the rate of relapse as a function of antipsychotic treatment (monotherapy vs. polypharmacy) in schizophrenic patients over a 2-year period.MethodsUsing data from a multicenter cohort study conducted in France, we performed a propensity-adjusted analysis to examine the association between the rate of relapse over a 2-year period and antipsychotic treatment (monotherapy vs. polypharmacy).ResultsOur sample consisted in 183 patients; 50 patients (27.3%) had at least one period of relapse and 133 had no relapse (72.7%). Thirty-eight (37.7) percent of the patients received polypharmacy. The most severely ill patients were given polypharmacy: the age at onset of illness was lower in the polypharmacy group (p = 0.03). Patients that received polypharmacy also presented a higher general psychopathology PANSS subscore (p = 0.04) but no statistically significant difference was found in the PANSS total score or the PANSS positive or negative subscales. These patients were more likely to be given prescriptions for sedative drugs (p < 0.01) and antidepressant medications (p = 0.03). Relapse was found in 23.7% of patients given monotherapy and 33.3% given polypharmacy (p = 0.16). After stratification according to quintiles of the propensity score, which eliminated all significant differences for baseline characteristics, antipsychotic polypharmacy was not statistically associated with an increase of relapse: HR = 1.686 (0.812; 2.505).ConclusionAfter propensity score adjustment, antipsychotic polypharmacy is not statistically associated to an increase of relapse. Future randomised studies are needed to assess the impact of antipsychotic polypharmacy in schizophrenia.

Antipsychotic Polypharmacy

“…5 Furthermore, APP was consistently related to greater illness severity or acuity. 5,7,36,40,47,53–55,61–65 Only risk of relapse was not increased in APP patients in 1 2-year study. 47 In addition, patients with APP showed less treatment improvement, 20 had less illness insight, 46,47 greater treatment resistance, 55,66 a history of violence, 60 and more negative symptoms.…”

“…32,43 Moreover, APP was more common in patients with earlier illness onset 47 and longer illness duration, 54–60 with only 1 study finding the opposite. 5 Furthermore, APP was consistently related to greater illness severity or acuity.…”

“…36,54,56,68,72,84,85,92,100,105–114 In addition, cotreatment with antidepressants, 47,70 anxiolytics, 47,54,70,79 and mood stabilizers 36,68,79 has also been associated with APP (see Table 4). …”

Healthcare resource use in schizophrenia, EuroSC findings

“…We studied the EuroSC cohort, a representative sample of schizophrenia patients from three European countries, which has been extensively used in prior research on this debilitating disease [15–25] Within this cohort, up to a third of patients were in HS2 or HS4 and experienced predominantly negative symptoms that were classed as moderate or severe, in line with earlier studies suggesting that negative symptoms of schizophrenia are indeed very common. In previous reports, 41% of patients experienced two or more negative symptoms [41], while as many as 58% had at least one negative symptom [42].…”

“…We used the European Schizophrenia Cohort (EuroSC) – a naturalistic 2-year follow-up of a cohort of 1,208 European schizophrenia patients [14]. Indeed, the EuroSC cohort has been extensively used in past research, which focused on investigating treatment efficacy [15], patients’ quality of life [16–18], employment [19], social contact [20,21] and subjective feelings of security and safety [22], as well as assessing caregiver burden [23] and quantifying direct health care costs associated with managing the disease [24,25]. …”