Cited by 153Schizophrenia research and treatmentPsychiatric care and mental health servicesBipolar Disorder and Treatment

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

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Taipale, Heidi, Mehtälä, Juha, Tanskanen, Antti, Tiihonen, Jari·2018·Schizophrenia Bulletin

Abstract

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.

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  • In addition to the benefits of reduced treatment gaps with LAI versus oral antipsychotics, studies, particularly those in real-world samples, have demonstrated reduced psychopathology, relapses, hospitalizations, and mortality risk with LAI formulations.

    “In addition to the benefits of reduced treatment gaps with LAI versus oral antipsychotics, studies, particularly those in real-world samples, have demonstrated reduced psychopathology, relapses, hospitalizations, and mortality risk with LAI formulations [98–104].”

    From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [102]

    The Results (Oral Vs LAI Comparisons) and Discussion report lower psychiatric and all-cause hospitalization risk during LAI use than oral antipsychotic use in this real-world schizophrenia cohort. Psychiatric rehospitalization is relevant to relapse, but the Discussion says the study’s outcomes were limited to hospitalization; it does not establish reduced psychopathology or mortality risk with LAIs. The mortality statement in the Discussion concerns clozapine, not LAIs. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • Both the clinical benefits and cost-effectiveness of the DPP lifestyle interventions was maintained over a 10-year follow up, even when compared to metformin as a control condition.

    “Furthermore, both the clinical benefits and cost-effectiveness of the DPP lifestyle interventions was maintained over a 10-year follow up, even when compared to metformin as a control condition.234,235”

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Authors
Taipale, H., Mehtälä, J., Tanskanen, A., & Tiihonen, J.
Affiliations
  • University of Eastern Finland (FI)
  • EPID Research Oy, Espoo, Finland
Corresponding author
Tiihonen, Jari
Venue
Schizophrenia Bulletin
Published
2017-12-20
Volume
44
Issue
6
Pages
1381-1387
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
OpenAlex
W2776169777
Cited by
153
References
15
Citations by year
2026: 5 · 2025: 7 · 2024: 16 · 2023: 16 · 2022: 25 · 2021: 35 · 2020: 21 · 2019: 21 · 2018: 7
FWCI
11.01
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UEF eRepo (University of Eastern Finland) (submittedVersion, cc-by-nc)
Funders
  • Finnish Ministry of Social Affairs
  • Niuvanniemi Hospital
  • Eli Lilly (F1D-HL-0341)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
schizophrenia, antipsychotic drugs
MeSH terms
Paliperidone Palmitate, Olanzapine, Adult, Aged, Clozapine, Female, Finland, Flupenthixol, Follow-Up Studies, Humans, Male, Middle Aged, Patient Readmission, Perphenazine, Schizophrenia, Antipsychotic Agents, Incidence, Prevalence, Secondary Prevention, Young Adult

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