Abstract
Extensive research has been carried out on the comparative effectiveness of antipsychotic medications. Most studies, however, have been performed in Western countries. The purpose of this study was to compare the effectiveness, indicated by time to any-cause discontinuation, of antipsychotic drugs in a large number of patients with schizophrenia in South Korea. We identified 1458 patients with schizophrenia or schizophreniform disorder who were treated with antipsychotic medications using a clinical data warehouse at the Seoul National University Hospital between March 2005 and February 2014. Kaplan–Meier survival analyses were used to estimate the time to discontinuation of antipsychotic drugs. We compared the survival curves of different antipsychotics using log-rank tests. Overall, the median time to discontinuation for any cause was 133 days (95% CI, 126–147). The longest time to discontinuation was observed for clozapine, followed by aripiprazole, paliperidone, olanzapine, amisulpride, risperidone, quetiapine, ziprasidone, and haloperidol. Specifically, clozapine was significantly different from all other antipsychotic drugs (all p < 0.001). Aripiprazole also had a significantly longer time to discontinuation than amisulpride (p = 0.001), risperidone (p < 0.001), quetiapine (p < 0.001), ziprasidone (p < 0.001), and haloperidol (p < 0.001). In Asian patients with schizophrenia, clozapine was the most effective antipsychotic in terms of time to discontinuation, followed by aripiprazole. This study extends the findings of previous effectiveness studies from Western populations and suggests the need to develop guidelines for the pharmacotherapy of schizophrenia tailored to Asian individuals.
Highlights
Pharmacotherapy with antipsychotic medication is a keystone of treatment for schizophrenia
To the best of our knowledge, this is the largest study examining the comparative effectiveness of antipsychotic medications as measured by time to any-cause discontinuation in an Asian sample
The present results indicate that clozapine demonstrated the best effectiveness for treatment continuation among antipsychotics
Summary
Pharmacotherapy with antipsychotic medication is a keystone of treatment for schizophrenia. Since the introduction of chlorpromazine in the 1950s, many antipsychotics have been developed, and 15–40 of these drugs are available across the world[1,2]. Along with this growth in antipsychotics, the comparative effectiveness of antipsychotic treatment has become a major area of interest within the field of clinical psychiatry. Time to all-cause medication discontinuation is widely used in the psychiatric field as a proxy measure of antipsychotic effectiveness because it integrates both patient and clinician perspectives on drug efficacy, safety, and tolerability[7].
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