Comparative Effectiveness of Antipsychotic Drugs for Rehospitalization in Schizophrenia-A Nationwide Study With 20-Year Follow-up

• Published in: Schizophrenia bulletin 2018-10, Vol.44 (6), p.1381-1387
• Main Authors: Taipale, Heidi, Mehtälä, Juha, Tanskanen, Antti, Tiihonen, Jari
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - pharmacology; Clozapine - administration & dosage; Clozapine - pharmacology; Female; Finland - epidemiology; Flupenthixol - pharmacology; Follow-Up Studies; Humans; Incidence; Male; Medicin och hälsovetenskap; Middle Aged; Olanzapine - administration & dosage; Olanzapine - pharmacology; Paliperidone Palmitate - pharmacology; Patient Readmission - statistics & numerical data; Perphenazine - pharmacology; Prevalence; Regular; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Secondary Prevention - statistics & numerical data; Young Adult
• ISSN: 0586-7614; 1745-1701; 1745-1701
• DOI: 10.1093/schbul/sbx176

Very little is known about the comparative long-term effectiveness of novel antipsychotics in relapse prevention, especially in first-episode schizophrenia. Nationwide data from Finnish health care registers were gathered prospectively for all persons with periods of inpatient care due to schizophrenia in Finland during 1972-2014. Altogether 62250 persons were included in the prevalent cohort, and 8719 in the incident (first-episode schizophrenia) cohort. The follow-up for antipsychotic use started at 1996 for the prevalent cohort, and at the first discharge from inpatient care for the incident cases. Within-individual Cox regression models for risk of psychiatric and all-cause hospitalization were constructed to compare risk during antipsychotic use and no use using individual as his/her own control to eliminate selection bias. With follow-up time up to 20 years (median = 14.1, interquartile range = 6.9-20.0), 59% of the prevalent cohort were readmitted to psychiatric inpatient care. Olanzapine long-acting injection (LAI; adjusted hazard ratio = 0.46, 95% confidence interval = 0.36-0.61), clozapine (0.51, 0.49-0.53), and paliperidone LAI (0.51, 0.40-0.66) were associated with the lowest risk of psychiatric rehospitalization in the prevalent cohort. Among first-episode patients, the lowest risks were observed for flupentixol LAI (0.24, 0.12-0.49), olanzapine LAI (0.26, 0.16-0.44), and perphenazine LAI (0.39, 0.31-0.50). Clozapine and LAIs were associated with the lowest risk of all-cause hospitalization in both cohorts. Clozapine and LAIs are the most effective treatments in preventing psychiatric and all-cause hospitalization among chronic and first-episode patients with schizophrenia.