Abstract
ObjectiveTo compare the rate of relapse as a function of antipsychotic treatment (monotherapy vs. polypharmacy) in schizophrenic patients over a 2-year period.MethodsUsing data from a multicenter cohort study conducted in France, we performed a propensity-adjusted analysis to examine the association between the rate of relapse over a 2-year period and antipsychotic treatment (monotherapy vs. polypharmacy).ResultsOur sample consisted in 183 patients; 50 patients (27.3%) had at least one period of relapse and 133 had no relapse (72.7%). Thirty-eight (37.7) percent of the patients received polypharmacy. The most severely ill patients were given polypharmacy: the age at onset of illness was lower in the polypharmacy group (p = 0.03). Patients that received polypharmacy also presented a higher general psychopathology PANSS subscore (p = 0.04) but no statistically significant difference was found in the PANSS total score or the PANSS positive or negative subscales. These patients were more likely to be given prescriptions for sedative drugs (p < 0.01) and antidepressant medications (p = 0.03). Relapse was found in 23.7% of patients given monotherapy and 33.3% given polypharmacy (p = 0.16). After stratification according to quintiles of the propensity score, which eliminated all significant differences for baseline characteristics, antipsychotic polypharmacy was not statistically associated with an increase of relapse: HR = 1.686 (0.812; 2.505).ConclusionAfter propensity score adjustment, antipsychotic polypharmacy is not statistically associated to an increase of relapse. Future randomised studies are needed to assess the impact of antipsychotic polypharmacy in schizophrenia.
Highlights
Antipsychotic medication is described as the cornerstone of schizophrenia treatment, as it offers benefits for controlling symptoms and preventing relapse
There was no significant difference in socio-demographic and clinical characteristics between the two groups, except for the age at onset of illness, which was lower in the polypharmacy group (p = 0.03), and the general psychopathology Positive and Negative Syndrome Scale (PANSS) score, which was higher in the polypharmacy group (p = 0.04)
As assessed with the Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Scale (BAS), and Simpson and Angus Scale (SAS), did not differ between the two groups, whereas we identified a higher proportion of patients with drugs to correct side effects in the polypharmacy group (p < 0.01)
Summary
Antipsychotic medication is described as the cornerstone of schizophrenia treatment, as it offers benefits for controlling symptoms and preventing relapse. One-fifth to one-third of people with schizophrenia are it remains unclear if there is an evidence base to support antipsychotic polypharmacy [3,6]. According to several observational studies, antipsychotic polypharmacy was associated with higher rates of extrapyramidal side effects than antipsychotic monotherapy. Antipsychotic polypharmacy was reported to decrease adherence to treatment and to increase relapse and mortality compared to antipsychotic monotherapy [3,6,10,11]. In a recent meta-analysis Correll et al [2] found that antipsychotic polypharmacy might be superior to monotherapy with respect to general measures of efficacy in certain clinical situations. Other studies did not find any statistical link between polypharmacy and mortality risk [12,13,14]
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