Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics

Outcomes Research, Eli Lilly and Company, Indianapolis, Indiana, USA.
BMC Psychiatry (Impact Factor: 2.24). 05/2005; 5:26. DOI: 10.1186/1471-244X-5-26
Source: PubMed

ABSTRACT Antipsychotic monotherapy is recognized as the treatment of choice for patients with schizophrenia. Simultaneous treatment with multiple antipsychotics (polypharmacy) is suggested by some expert consensus guidelines as the last resort after exhausting monotherapy alternatives. This study assessed the annual rate and duration of antipsychotic monotherapy and its inverse, antipsychotic polypharmacy, among schizophrenia patients initiated on commonly used atypical antipsychotic medications.
Data were drawn from a large prospective naturalistic study of patients treated for schizophrenia-spectrum disorders, conducted 7/1997-9/2003. Analyses focused on patients (N = 796) who were initiated during the study on olanzapine (N = 405), quetiapine (N = 115), or risperidone (N = 276). The percentage of patients with monotherapy on the index antipsychotic over the 1-year post initiation, and the cumulative number of days on monotherapy were calculated for all patients and for each of the 3 atypical antipsychotic treatment groups. Analyses employed repeated measures generalized linear models and non-parametric bootstrap re-sampling, controlling for patient characteristics.
During the 1-year period, only a third (35.7%) of the patients were treated predominately with monotherapy (> 300 days). Most patients (57.7%) had at least one prolonged period of antipsychotic polypharmacy (> 60 consecutive days). Patients averaged 195.5 days on monotherapy, 155.7 days on polypharmacy, and 13.9 days without antipsychotic therapy. Olanzapine-initiated patients were significantly more likely to be on monotherapy with the initiating antipsychotic during the 1-year post initiation compared to risperidone (p = .043) or quetiapine (p = .002). The number of monotherapy days was significantly greater for olanzapine than quetiapine (p < .001), but not for olanzapine versus risperidone, or for risperidone versus quetiapine-initiated patients.
Despite guidelines recommending the use of polypharmacy only as a last resort, the use of antipsychotic polypharmacy for prolonged periods is very common during the treatment of schizophrenia patients in usual care settings. In addition, in this non-randomized naturalistic observational study, the most commonly used atypical antipsychotics significantly differed on the rate and duration of antipsychotic monotherapy. Reasons for and the impact of the predominant use of polypharmacy will require further study.

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    • "The concurrent use of two or more antipsychotic drugs, also called 'antipsychotic polypharmacy' (Tapp et al., 2005), is common in clinical practice (Faries et al., 2005). The frequency of American schizophrenia patients on APP increased from 32% in 1998 to 41% by 2000 (Ganguly et al., 2004). "
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    ABSTRACT: This study examined the use, demographic and clinical correlates of antipsychotic polypharmacy (APP) and its associations with treatment satisfaction and quality of life (QOL) in schizophrenia patients in China.
    Australian and New Zealand Journal of Psychiatry 06/2014; 49(2). DOI:10.1177/0004867414536931 · 3.77 Impact Factor
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    • "This trend may be supported by evidence suggesting that risperidone and olanzapine seem to be more effective than other first line SGA [31]. Faries et al. found that olanzapineinitiated patients were significantly more likely to be on monotherapy with the initiating antipsychotic during the 1-year post initiation compared to risperidone or quetiapine [30]. Moreover, the predicted mean number of days on baseline monotherapy was significantly longer for olanzapine than for risperidone, quetiapine, or amisulpride [28]. "
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    ABSTRACT: Background The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. Methods Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September–December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. Results At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. Conclusions The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.
    Pharmacological reports: PR 01/2014; 66(4):613–617. · 2.17 Impact Factor
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    • "Bár a szkizofrénia kezelésre vonatkozó ajánlások az antipszichotikumok alkalmazását alapvetően monoterápiában javasolják (NICE, 2009; EüM, 2005; Lehman et al., 2004), a mindennapi gyakorlatban a kombináció alkalmazása mégis meglehetősen elterjedt (Bolstad et al., 2011; Országos Egészségbiztosítási Pénztár, 2008). Egy USA-ban végzett egyéves naturalisztikus vizsgálattal igyekeztek szkizofrén betegek (n=2327) antipszichotikus kezelésének gyakorlatát feltárni (Faries et al., 2005). A vizsgálat eredménye alapján a betegek közel kétharmada az év folyamán 60 napnál hosszabb ideig részesült kombinált antipszichotikus kezelésben, miközben a betegek mintegy 27%-a az év legnagyobb részében (min. "
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    ABSTRACT: Main indication for antipsychotic medication is the treatment of schizophrenia and other psychotic disorders. Influential protocols in the treatment of schizophrenia recommend the use of antipsychotics in monotherapy. In case of therapy resistance, combination of antipsychotics is a feasible option. Applying antipsychotics in combination is common in clinical practice, although existing efficacy and safety data concerning antipsychotic combinations are scarce. Authors, after reviewing existing scientific data, make attempt to give recommendations for combined antipsychotic therapy in everyday clinical practice.
    Neuropsychopharmacologia Hungarica: a Magyar Pszichofarmakológiai Egyesület lapja = official journal of the Hungarian Association of Psychopharmacology 09/2012; 14(3):189-95.
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