TY - JOUR
T1 - Time to discontinuation of first- and second-generation antipsychotic medications in the treatment of schizophrenia
AU - Kreyenbuhl, Julie
AU - Slade, Eric P.
AU - Medoff, Deborah R.
AU - Brown, Clayton H.
AU - Ehrenreich, Benjamin
AU - Afful, Joseph
AU - Dixon, Lisa B.
N1 - Funding Information:
Author Dixon is the Principal Investigator of a project funded by Ortho McNeil Janssen Scientific Affairs, “Addressing Adherence in the Treatment of Schizophrenia and Other Severe Mental Illnesses”. This project convened a meeting of experts to develop research and policy agendas regarding the issue of disparities and non-adherence among individuals with severe mental illness. She also is a consultant for the Ortho McNeil Janssen study, “Post-Release from Incarceration Determination of Antipsychotic Effectiveness (PRIDE)”.
Funding Information:
Funding for this study was provided by the VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC); the VISN 5 MIRECC had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
PY - 2011/9
Y1 - 2011/9
N2 - Background: Continuous adherence to antipsychotic treatment is critical for individuals with schizophrenia to benefit optimally, yet studies have shown rates of antipsychotic discontinuation to be high with few differences across medications. We investigated discontinuation of selected first- and second-generation antipsychotics among individuals with schizophrenia receiving usual care in a VA healthcare network in the U.S. mid-Atlantic region. Methods: We identified 2138 VA patients with schizophrenia who initiated antipsychotic treatment with one of five non-clozapine second-generation antipsychotics or either of the two most commonly prescribed first-generation agents between 1/2004 and 9/2006. The dependent variable was duration of continuous antipsychotic possession from the index prescription until the first gap of more than 45. days between prescriptions. We used the Cox proportional hazards model to compare the hazard of discontinuation among the seven antipsychotics controlling for patient demographic and clinical characteristics. The reference group was olanzapine. Results: The majority of patients (84%) discontinued their index antipsychotic during the follow-up period (up to 33. months). In multivariable analysis, only risperidone had a significantly greater hazard of discontinuation compared to olanzapine (Adjusted hazard ratio = 1.15, 95% CI: 1.02-1.30, p = .025). Younger age, non-white race, homelessness, substance use disorder, recent inpatient mental health hospitalization, and prescription of another antipsychotic were also associated with earlier discontinuation. Conclusions: Examination of a usual care sample of individuals with schizophrenia revealed short durations of antipsychotic use, with only risperidone having a shorter time to discontinuation than olanzapine. These findings demonstrate that current antipsychotic agents have limited overall acceptability by patients in usual care.
AB - Background: Continuous adherence to antipsychotic treatment is critical for individuals with schizophrenia to benefit optimally, yet studies have shown rates of antipsychotic discontinuation to be high with few differences across medications. We investigated discontinuation of selected first- and second-generation antipsychotics among individuals with schizophrenia receiving usual care in a VA healthcare network in the U.S. mid-Atlantic region. Methods: We identified 2138 VA patients with schizophrenia who initiated antipsychotic treatment with one of five non-clozapine second-generation antipsychotics or either of the two most commonly prescribed first-generation agents between 1/2004 and 9/2006. The dependent variable was duration of continuous antipsychotic possession from the index prescription until the first gap of more than 45. days between prescriptions. We used the Cox proportional hazards model to compare the hazard of discontinuation among the seven antipsychotics controlling for patient demographic and clinical characteristics. The reference group was olanzapine. Results: The majority of patients (84%) discontinued their index antipsychotic during the follow-up period (up to 33. months). In multivariable analysis, only risperidone had a significantly greater hazard of discontinuation compared to olanzapine (Adjusted hazard ratio = 1.15, 95% CI: 1.02-1.30, p = .025). Younger age, non-white race, homelessness, substance use disorder, recent inpatient mental health hospitalization, and prescription of another antipsychotic were also associated with earlier discontinuation. Conclusions: Examination of a usual care sample of individuals with schizophrenia revealed short durations of antipsychotic use, with only risperidone having a shorter time to discontinuation than olanzapine. These findings demonstrate that current antipsychotic agents have limited overall acceptability by patients in usual care.
KW - Antipsychotic medication
KW - Discontinuation
KW - Schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=79960428793&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960428793&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2011.04.028
DO - 10.1016/j.schres.2011.04.028
M3 - Article
C2 - 21576008
AN - SCOPUS:79960428793
SN - 0920-9964
VL - 131
SP - 127
EP - 132
JO - Schizophrenia Research
JF - Schizophrenia Research
IS - 1-3
ER -