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

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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

DOI 10.1093/schbul/sbx176PMC PMC6192491

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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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Fig. 1. Risk of psychiatric rehospitalization in monotherapy of specific antipsychotics in comparison to no use of antipsychotic in the prevalent cohort, within-individual model.CC BY-NC · PubMed Central

Fig. 2. Risk of psychiatric rehospitalization in monotherapy of specific antipsychotics in comparison to no use of antipsychotic in the incident cohort, within-individual model.CC BY-NC · PubMed Central

Fig. 3. Risk of all-cause hospitalization in monotherapy of specific antipsychotics in comparison to no use of antipsychotic in the prevalent cohort, within-individual model.CC BY-NC · PubMed Central

Fig. 4. Risk of all-cause hospitalization in monotherapy of specific antipsychotics in comparison to no use of antipsychotic in the incident cohort.CC BY-NC · PubMed Central

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Self-citation

Authors: Taipale, H., Mehtälä, J., Tanskanen, A., & Tiihonen, J.
Affiliations: University of Eastern Finland (FI)
EPID Research Oy, Espoo, Finland
Corresponding author: Tiihonen, Jari
ORCID: Taipale, Heidi
Mehtälä, Juha
Tanskanen, Antti
Tiihonen, Jari
Venue: Schizophrenia Bulletin
Publisher: Oxford University Press (OUP)
Published: 2017-12-20
Volume: 44
Issue: 6
Pages: 1381-1387
ISSN: 0586-7614 (ISSN-L)
1745-1701
DOI: 10.1093/schbul/sbx176
PMC: PMC6192491
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: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (vor)
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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Comparative Effectiveness of Antipsychotic Drugs for Rehospitalization in Schizophrenia—A Nationwide Study With 20-Year Follow-up

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