Real-world effectiveness of antipsychotic treatments in 1011 acutely hospitalized patients with schizophrenia: A one-year follow-up study

Kotaro Hatta; Shigemasa Katayama; Takuya Ishizuka; Yasuhiko Sudo; Mitsuru Nakamura; Hana Hasegawa; Atsushi Imai; Fumiyoshi Morikawa; Tatsuhiro Shimada; Fuminari Misawa; Shigeru Ozaki; Kiyoshi Fujita; Haruo Watanabe; Hiroyuki Nakamura; Naoya Sugiyama; JAST study group

doi:10.1016/j.ajp.2021.102917

Real-world effectiveness of antipsychotic treatments in 1011 acutely hospitalized patients with schizophrenia: A one-year follow-up study

Asian J Psychiatr. 2022 Jan:67:102917. doi: 10.1016/j.ajp.2021.102917. Epub 2021 Nov 6.

Authors

Affiliations

¹ Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan. Electronic address: khatta@juntendo.ac.jp.
² Seijin Hospital, Tokyo, Japan.
³ Hasegawa Hospital, Tokyo, Japan.
⁴ Tosa Hospital, Kochi, Japan.
⁵ Narimasu Kosei Hospital, Tokyo, Japan.
⁶ Numazu Chuo Hospital, Numazu, Japan.
⁷ Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
⁸ Asahikawa Keisenkai Hospital, Asahikawa, Japan.
⁹ Tochigi Prefectural Okamotodai Hospital, Utsunomiya, Japan.
¹⁰ Yamanashi Prefectural Kita Hospital, Nirasaki, Japan.
¹¹ Toshima Hospital, Tokyo, Japan.
¹² The Okehazama Hospital, Toyoake, Japan.
¹³ Sawa Hospital, Osaka, Japan.
¹⁴ Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.

PMID: 34875558
DOI: 10.1016/j.ajp.2021.102917

Abstract

Purpose: To compare the real-world effectiveness of antipsychotic treatments focusing on long-acting injectable antipsychotic medications (LAIs) and antipsychotic polytherapies except polytherapy involving clozapine (APEC) for patients with schizophrenia.

Methods: This prospective study was conducted over a 19-month period in 12 psychiatric emergency hospitals in Japan. Patients who were newly admitted to psychiatric emergency wards between September 2019 and March 2020 because of acute onset or exacerbation of Schizophrenia and Other Psychotic Disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were included. All patients were followed for one-year after discharge or until March 31, 2021. The primary outcome was the risk of treatment failure defined as psychiatric rehospitalization, discontinuation of medication, death, or continuation of hospitalization for one year. Cox proportional hazards multivariate regression was used for analyses.

Results: A total of 1011 patients were enrolled (women, 53.7%; mean [SD] age, 47.5 [14.8] years). During follow-up, 588 patients (58.2%) experienced treatment failure including rehospitalization (513 patients), discontinuation of medication (17 patients), death (11 patients), and continuation of hospitalization for one-year (47 patients). Switching to LAIs (hazard ratio [HR] 0.810, 95%CI 0.659-0.996) and APEC (HR 0.829, 95%CI 0.695-0.990) were significantly associated with a low rate of treatment failure.

Conclusions: Switching to LAIs and APEC in early non-responders seems to be beneficial for the prevention of treatment failure in acutely admitted patients with schizophrenia. The risk of treatment failure was about 19% and 17% lower in patients treated with LAIs and APEC, respectively, than in patients treated without them.

Keywords: Antipsychotic polytherapy; Long-acting injectable antipsychotic medication; Psychiatric emergency; Real-world; Schizophrenia.

MeSH terms

Antipsychotic Agents* / therapeutic use
Delayed-Action Preparations / therapeutic use
Female
Follow-Up Studies
Humans
Middle Aged
Prospective Studies
Schizophrenia* / drug therapy

Substances

Antipsychotic Agents
Delayed-Action Preparations