Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder

Jonne Lintunen; Heidi Taipale; Antti Tanskanen; Ellenor Mittendorfer-Rutz; Jari Tiihonen; Markku Lähteenvuo

doi:10.1093/schbul/sbab004

Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder

Schizophr Bull. 2021 Jul 8;47(4):1099-1107. doi: 10.1093/schbul/sbab004.

Authors

Jonne Lintunen¹, Heidi Taipale^{1

2

3}, Antti Tanskanen^{1

2}, Ellenor Mittendorfer-Rutz², Jari Tiihonen^{1

2

4}, Markku Lähteenvuo¹

Affiliations

¹ Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
² Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
³ School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
⁴ Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden.

Abstract

Objective: To investigate the long-term real-world effectiveness of antipsychotics and other psychopharmacotherapies in the treatment of schizoaffective disorder (SCHAFF).

Method: Two nationwide cohorts of SCHAFF patients were identified from Finnish and Swedish registers. Within-individual design was used with stratified Cox regression. The main exposure was use of antipsychotics. Adjunctive pharmacotherapies included mood stabilizers, antidepressants, and benzodiazepines and benzodiazepine-related drugs. The main outcome was hospitalization due to psychosis.

Results: The Finnish cohort included 7655 and the Swedish cohort 7525 patients. Median follow-up time was 11.2 years (IQR 5.6-11.5) in the Finnish and 7.6 years (IQR 3.8-10.3) in the Swedish cohort. Clozapine and long-acting injectable (LAI) antipsychotics were consistently associated with a decreased risk of psychosis hospitalization and treatment failure (psychiatric hospitalization, any change in medication, death) in both cohorts. Quetiapine was not associated with a decreased risk of psychosis hospitalization. Mood stabilizers used in combination with antipsychotics were associated with a decreased risk of psychosis hospitalization (Finnish cohort HR 0.76, 95% CI 0.71-0.81; Swedish cohort HR 0.84, 0.78-0.90) when compared with antipsychotic monotherapy. Combination of antidepressants and antipsychotics was associated with a decreased risk of psychosis hospitalization in the Swedish cohort (HR 0.90, 0.83-0.97) but not in the Finnish cohort (1.00, 0.94-1.07), and benzodiazepine use was associated with an increased risk (Finnish cohort HR 1.07, 1.01-1.14; Swedish cohort 1.21, 1.13-1.30).

Conclusions: Clozapine, LAIs, and combination therapy with mood stabilizers were associated with the best outcome and use of quetiapine and benzodiazepines with the worst outcome in the treatment of SCHAFF.

Keywords: antidepressants; antipsychotics; benzodiazepines; mood stabilizers; psychiatric hospitalization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antipsychotic Agents / therapeutic use*
Cohort Studies
Female
Finland
Follow-Up Studies
Humans
Male
Middle Aged
Psychotic Disorders / drug therapy*
Sweden
Time Factors
Treatment Outcome

Substances

Antipsychotic Agents