TY - JOUR
T1 - Effectiveness of switching from antipsychotic polypharmacy to monotherapy
AU - Essock, Susan M.
AU - Schooler, Nina R.
AU - Stroup, T. Scott
AU - McEvoy, Joseph Patrick
AU - Rojas, Ingrid
AU - Jackson, Carlos
AU - Covell, Nancy H.
AU - Adler, L.
AU - Byerly, M.
AU - Caroff, S.
AU - Csernansky, J.
AU - D'Souza, C.
AU - Jackson, C.
AU - Manschreck, T.
AU - McEvoy, J.
AU - Miller, A.
AU - Nasrallah, H.
AU - Olson, S.
AU - Patel, J.
AU - Saltz, B.
AU - Steinbook, R. M.
AU - Tapp, A.
PY - 2011/7
Y1 - 2011/7
N2 - Objective: This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy. Method: Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time. Results: Patients assigned to switch to monotherapy had shorter times to allcause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight. Conclusions: Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.
AB - Objective: This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy. Method: Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time. Results: Patients assigned to switch to monotherapy had shorter times to allcause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight. Conclusions: Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.
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U2 - 10.1176/appi.ajp.2011.10060908
DO - 10.1176/appi.ajp.2011.10060908
M3 - Article
C2 - 21536693
AN - SCOPUS:79960551424
SN - 0002-953X
VL - 168
SP - 702
EP - 708
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 7
ER -