Remaining relapse-free key to long-term antipsychotic discontinuation
In a 10-year follow-up study of more than 100 patients with first-episode psychosis, researchers found that remaining relapse-free was the most significant predictor of successful long-term antipsychotic medication discontinuation.
“Identifying clinical features of illness associated with lesser or greater likelihood of successfully discontinuing antipsychotic medication is of considerable importance,” Christy L. M. Hui, PhD, from the department of psychiatry, University of Hong Kong, and colleagues wrote in a research letter published in JAMA Psychiatry.
Researchers examined factors relating to successful discontinuation of antipsychotic medication during long-term follow-up of patients with first-episode psychosis. The participants were from a 1-year randomized clinical trial comparing medication maintenance vs. discontinuation to prevent relapse after resolution of initial psychotic symptoms in Hong Kong. Successful discontinuation was defined as having not received any antipsychotics during the last 2 years of follow-up and being free of key positive psychosis symptoms.
Successful discontinuation occurred among 16% of patients (23 of 142) in the last 2 years of follow-up. According to multivariate regression analysis, being relapse-free from baseline was the only statistically significant factor associated with successful antipsychotic discontinuation during long-term follow-up (OR = 8.65; 95% CI, 2.65-28.27).
Compared with the group who continued to receive medication or experience persistent positive symptoms, the group who successfully discontinued included more men (42% vs. 65%). This group was also more likely to have a shorter duration of untreated psychosis (35% vs. 13%; OR = 3.43; 95% CI, 1.25-9.4) and be relapse-free from baseline (65% vs. 13%; OR = 13; 95% CI, 4.71-35.86).
In the first 2 years after the trial began, the group of patients who discontinued antipsychotics had a higher Social and Occupational Functioning Assessment Scale mean score (63.5 vs. 60.1; OR = 1.1; 95% CI, 1.02-1.19) and showed a lower Stroop interference result at baseline (54.5 vs. 71.5; OR = 0.95; 95% CI, 0.92-0.99), according to Hui and colleagues. The group also consisted of fewer patients with schizophrenia spectrum disorders (74% vs. 94%; OR = 0.18; 95% CI, 0.05-0.59).
“Remaining relapse-free was the central most important predictor of successful long-term discontinuation, supporting interventions to prevent relapse,” the researchers wrote. “The present findings suggest early evaluation of this measure could contribute to assessment of prognosis.” – by Savannah Demko
Disclosure: Hui reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.