Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial

Objective To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment.Design 12 month randomised, double blind, placebo controlled trial.Setting Early psychosis outpatient clinic...

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Published in:BMJ 2010-08, Vol.341 (7770), p.435-435
Main Authors: Chen, Eric Y H, Hui, Christy L M, Lam, May M L, Chiu, Cindy P Y, Law, C W, Chung, Dicky W S, Tso, Steve, Pang, Edwin P F, Chan, K T, Wong, Y C, Mo, Flora Y M, Chan, Kathy P M, Yao, T J, Hung, S F, Honer, William G
Format: Article
Language:English
Subjects:
Antipsychotic Agents - therapeutic use
Antipsychotic drugs
Antipsychotics
Chronic illnesses
Clinical trials
Clinical Trials (Epidemiology)
Dibenzothiazepines - therapeutic use
Discontinued
Double-Blind Method
Drug development
Drugs: Psychiatry
Epidemiology
Evidence-based medicine
Female
First time
Hallucinations
High functioning
Humans
Male
Medical treatment
Patients
Placebos
Psychiatry
Psychosis
Psychotherapy
Psychotic Disorders (Incl Schizophrenia)
Psychotic Disorders - drug therapy
Psychotropic drugs
Quetiapine
Quetiapine Fumarate
Recurrence
Relapse
Schizophrenia
Substance abuse treatment
Survival analysis
Symptoms
Time Factors
Treatment Outcome
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container_end_page 435
container_issue 7770
container_start_page 435
container_title BMJ
container_volume 341
creator Chen, Eric Y H
Hui, Christy L M
Lam, May M L
Chiu, Cindy P Y
Law, C W
Chung, Dicky W S
Tso, Steve
Pang, Edwin P F
Chan, K T
Wong, Y C
Mo, Flora Y M
Chan, Kathy P M
Yao, T J
Hung, S F
Honer, William G
description Objective To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment.Design 12 month randomised, double blind, placebo controlled trial.Setting Early psychosis outpatient clinics in Hong Kong.Participants 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis.Interventions Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred.Main outcome measure Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds.Results 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P
doi_str_mv 10.1136/bmj.c4024
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The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P&lt;0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; χ2=3.20, df=1; P=0.07).Conclusion In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year.Trial registration Clinical trials NCT00334035.</description><edition>International edition</edition><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-8146</identifier><identifier>ISSN: 0959-535X</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.c4024</identifier><identifier>PMID: 20724402</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Antipsychotic Agents - therapeutic use ; Antipsychotic drugs ; Antipsychotics ; Chronic illnesses ; Clinical trials ; Clinical Trials (Epidemiology) ; Dibenzothiazepines - therapeutic use ; Discontinued ; Double-Blind Method ; Drug development ; Drugs: Psychiatry ; Epidemiology ; Evidence-based medicine ; Female ; First time ; Hallucinations ; High functioning ; Humans ; Male ; Medical treatment ; Patients ; Placebos ; Psychiatry ; Psychosis ; Psychotherapy ; Psychotic Disorders (Incl Schizophrenia) ; Psychotic Disorders - drug therapy ; Psychotropic drugs ; Quetiapine ; Quetiapine Fumarate ; Recurrence ; Relapse ; Schizophrenia ; Substance abuse treatment ; Survival analysis ; Symptoms ; Time Factors ; Treatment Outcome</subject><ispartof>BMJ, 2010-08, Vol.341 (7770), p.435-435</ispartof><rights>Chen et al 2010</rights><rights>2010 BMJ Publishing Group Ltd</rights><rights>Copyright: 2010 © Chen et al 2010</rights><rights>Copyright BMJ Publishing Group Aug 28, 2010</rights><rights>Chen et al 2010 2010 Chen et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b611t-73a3701639577dc40c92bcbd92ccbd94f140df09d7a15bfb39b75847a8706aab3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/341/bmj.c4024.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/341/bmj.c4024.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,780,784,885,3194,27924,27925,30999,31000,58238,58471,77594,77595</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20724402$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Eric Y H</creatorcontrib><creatorcontrib>Hui, Christy L M</creatorcontrib><creatorcontrib>Lam, May M L</creatorcontrib><creatorcontrib>Chiu, Cindy P Y</creatorcontrib><creatorcontrib>Law, C W</creatorcontrib><creatorcontrib>Chung, Dicky W S</creatorcontrib><creatorcontrib>Tso, Steve</creatorcontrib><creatorcontrib>Pang, Edwin P F</creatorcontrib><creatorcontrib>Chan, K T</creatorcontrib><creatorcontrib>Wong, Y C</creatorcontrib><creatorcontrib>Mo, Flora Y M</creatorcontrib><creatorcontrib>Chan, Kathy P M</creatorcontrib><creatorcontrib>Yao, T J</creatorcontrib><creatorcontrib>Hung, S F</creatorcontrib><creatorcontrib>Honer, William G</creatorcontrib><title>Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Objective To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment.Design 12 month randomised, double blind, placebo controlled trial.Setting Early psychosis outpatient clinics in Hong Kong.Participants 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis.Interventions Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred.Main outcome measure Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds.Results 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P&lt;0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; χ2=3.20, df=1; P=0.07).Conclusion In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year.Trial registration Clinical trials NCT00334035.</description><subject>Antipsychotic Agents - therapeutic use</subject><subject>Antipsychotic drugs</subject><subject>Antipsychotics</subject><subject>Chronic illnesses</subject><subject>Clinical trials</subject><subject>Clinical Trials (Epidemiology)</subject><subject>Dibenzothiazepines - therapeutic use</subject><subject>Discontinued</subject><subject>Double-Blind Method</subject><subject>Drug development</subject><subject>Drugs: Psychiatry</subject><subject>Epidemiology</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>First time</subject><subject>Hallucinations</subject><subject>High functioning</subject><subject>Humans</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Patients</subject><subject>Placebos</subject><subject>Psychiatry</subject><subject>Psychosis</subject><subject>Psychotherapy</subject><subject>Psychotic Disorders (Incl Schizophrenia)</subject><subject>Psychotic Disorders - drug therapy</subject><subject>Psychotropic drugs</subject><subject>Quetiapine</subject><subject>Quetiapine Fumarate</subject><subject>Recurrence</subject><subject>Relapse</subject><subject>Schizophrenia</subject><subject>Substance abuse treatment</subject><subject>Survival analysis</subject><subject>Symptoms</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0959-8138</issn><issn>0959-8146</issn><issn>0959-535X</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>7QJ</sourceid><recordid>eNqFksFu1DAQhiMEoqulBx4AZEElxCHFjp047gEJrYAitcBhWY6Wkzisl8QOttOyT8RrMkvKakEqXOyR5vM_438mSR4SfEoILV5U_ea0Zjhjd5IZYUWZ5iWld5MZFrlIS0LLo-Q4hA3GOKO8FEV-PznKMM8YvJklPy6VsVFbZWuNotcq9tpGdG3iGn0bdTRqMFajK-3DGFBjQu1sNHZU0TiLVBu1Rw6ArVYQtAcSxqIBKAjDJOd1b2LUDWqNDxHpwQTXaDSEbb12wYQz5JVtXG8CMLsy3nUdhNEb1T1I7rWqC_r45p4nn968Xi7O04sPb98tXl2kVUFITDlVlGNSUJFz3oAttciqumpEVu9O1hKGmxaLhiuSV21FRcXzknFVclwoVdF58nLSHcaq100N7XvVycGbXvmtdMrIPzPWrOUXdyUzAY7yHASe3Qh4BwaGKOFDte46ZbUbg4RyBAuaZf8nGUyr5KQE8slf5MaN3oIPIEdLnOecAPT0NogIgjmjgrB_UpyXmBY021HPJ6r2LgSv270BBMvd1knYOvlr64B9fOjYnvy9YwA8moBNiM4f5osig1HNk3TKmxD1931e-a-y4JTn8v1qIT9_PF9erlZMLoE_mfhdD7f39ROIzPtd</recordid><startdate>20100819</startdate><enddate>20100819</enddate><creator>Chen, Eric Y H</creator><creator>Hui, Christy L M</creator><creator>Lam, May M L</creator><creator>Chiu, Cindy P Y</creator><creator>Law, C W</creator><creator>Chung, Dicky W S</creator><creator>Tso, Steve</creator><creator>Pang, Edwin P F</creator><creator>Chan, K T</creator><creator>Wong, Y C</creator><creator>Mo, Flora Y M</creator><creator>Chan, Kathy P M</creator><creator>Yao, T J</creator><creator>Hung, S F</creator><creator>Honer, William G</creator><general>British Medical Journal Publishing Group</general><general>British Medical Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7QJ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20100819</creationdate><title>Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial</title><author>Chen, Eric Y H ; Hui, Christy L M ; Lam, May M L ; Chiu, Cindy P Y ; Law, C W ; Chung, Dicky W S ; Tso, Steve ; Pang, Edwin P F ; Chan, K T ; Wong, Y C ; Mo, Flora Y M ; Chan, Kathy P M ; Yao, T J ; Hung, S F ; Honer, William G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b611t-73a3701639577dc40c92bcbd92ccbd94f140df09d7a15bfb39b75847a8706aab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Antipsychotic Agents - therapeutic use</topic><topic>Antipsychotic drugs</topic><topic>Antipsychotics</topic><topic>Chronic illnesses</topic><topic>Clinical trials</topic><topic>Clinical Trials (Epidemiology)</topic><topic>Dibenzothiazepines - therapeutic use</topic><topic>Discontinued</topic><topic>Double-Blind Method</topic><topic>Drug development</topic><topic>Drugs: Psychiatry</topic><topic>Epidemiology</topic><topic>Evidence-based medicine</topic><topic>Female</topic><topic>First time</topic><topic>Hallucinations</topic><topic>High functioning</topic><topic>Humans</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Patients</topic><topic>Placebos</topic><topic>Psychiatry</topic><topic>Psychosis</topic><topic>Psychotherapy</topic><topic>Psychotic Disorders (Incl Schizophrenia)</topic><topic>Psychotic Disorders - drug therapy</topic><topic>Psychotropic drugs</topic><topic>Quetiapine</topic><topic>Quetiapine Fumarate</topic><topic>Recurrence</topic><topic>Relapse</topic><topic>Schizophrenia</topic><topic>Substance abuse treatment</topic><topic>Survival analysis</topic><topic>Symptoms</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Eric Y H</creatorcontrib><creatorcontrib>Hui, Christy L M</creatorcontrib><creatorcontrib>Lam, May M L</creatorcontrib><creatorcontrib>Chiu, Cindy P Y</creatorcontrib><creatorcontrib>Law, C W</creatorcontrib><creatorcontrib>Chung, Dicky W S</creatorcontrib><creatorcontrib>Tso, Steve</creatorcontrib><creatorcontrib>Pang, Edwin P F</creatorcontrib><creatorcontrib>Chan, K T</creatorcontrib><creatorcontrib>Wong, Y C</creatorcontrib><creatorcontrib>Mo, Flora Y M</creatorcontrib><creatorcontrib>Chan, Kathy P M</creatorcontrib><creatorcontrib>Yao, T J</creatorcontrib><creatorcontrib>Hung, S F</creatorcontrib><creatorcontrib>Honer, William G</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P&lt;0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; χ2=3.20, df=1; P=0.07).Conclusion In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year.Trial registration Clinical trials NCT00334035.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>20724402</pmid><doi>10.1136/bmj.c4024</doi><tpages>1</tpages><edition>International edition</edition><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0959-8138
ispartof BMJ, 2010-08, Vol.341 (7770), p.435-435
issn 0959-8138
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0959-535X
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language eng
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source Applied Social Sciences Index & Abstracts (ASSIA); JSTOR Archival Journals and Primary Sources Collection; BMJ Journals
subjects Antipsychotic Agents - therapeutic use
Antipsychotic drugs
Antipsychotics
Chronic illnesses
Clinical trials
Clinical Trials (Epidemiology)
Dibenzothiazepines - therapeutic use
Discontinued
Double-Blind Method
Drug development
Drugs: Psychiatry
Epidemiology
Evidence-based medicine
Female
First time
Hallucinations
High functioning
Humans
Male
Medical treatment
Patients
Placebos
Psychiatry
Psychosis
Psychotherapy
Psychotic Disorders (Incl Schizophrenia)
Psychotic Disorders - drug therapy
Psychotropic drugs
Quetiapine
Quetiapine Fumarate
Recurrence
Relapse
Schizophrenia
Substance abuse treatment
Survival analysis
Symptoms
Time Factors
Treatment Outcome
title Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial
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