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Cited by 151Schizophrenia research and treatmentBipolar Disorder and TreatmentMental Health and Psychiatry

Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial

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Chen, E. Y. H., Hui, C. L. M., Lam, M. M. L., Chiu, C. P. Y., Law, C. W., Chung, D. W. S., Tso, S., Pang, E. P. F. +7 more·2010·BMJ
DOI 10.1136/bmj.c4024PMC PMC2924475
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Abstract

OBJECTIVE: To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment. DESIGN: 12 month randomised, double blind, placebo controlled trial. SETTING: Early psychosis outpatient clinics in Hong Kong. PARTICIPANTS: 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis. INTERVENTIONS: Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred. MAIN OUTCOME MEASURE: Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds. RESULTS: 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P<0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; chi(2)=3.20, df=1; P=0.07). CONCLUSION: In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year. Trial registration Clinical trials NCT00334035.

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  • Relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.

    “That is, relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [59]

    The Results (Primary outcome: relapse; page not provided) report that only 23 of 83 relapses occurred within 60 days of randomisation; 60 occurred later. The Methods (Statistical analysis; page not provided) identify those first 60 days as the period when relapse might be related to switching medication. The reported relapses therefore did not occur predominantly around drug cessation. (LLM, conf=0.87)

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  • Relapse rates are raised in the discontinuation group for 1-3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.

    “It appears that relapse rates are raised in the discontinuation group for 1–3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.3,56–59”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [59]

    The Results (Primary outcome: relapse; page not provided) show higher relapse in the placebo-discontinuation group than in the quetiapine group at 12 months. The paper does not establish that the difference persists for 1–3 years or that relapse rates converge thereafter; its reported comparison ends at 12 months. (LLM, conf=0.88)

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Authors
Chen, E. Y. H., Hui, C. L. M., Lam, M. M. L., Chiu, C. P. Y., Law, C. W., Chung, D. W. S., Tso, S., Pang, E. P. F., Chan, K. T., Wong, Y. C., Mo, F. Y. M., Chan, K. P. M., Yao, T. J., Hung, S. F., & Honer, W. G.
Affiliations
  • University of Hong Kong (HK)
  • Queen Mary Hospital (CN)
  • Tai Po Hospital (CN)
  • Castle Peak Hospital (CN)
  • Kwai Chung Hospital (CN)
  • University of British Columbia (CA)
Corresponding author
Chen, E. Y. H.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2010-08-19
Volume
341
Issue
aug19 1
Pages
c4024-c4024
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.c4024
PMC
PMC2924475
OpenAlex
W2006350866
Cited by
151
References
57
Citations by year
2026: 2 · 2025: 5 · 2024: 8 · 2023: 10 · 2022: 6 · 2021: 15 · 2020: 13 · 2019: 13 · 2018: 14 · 2017: 5 · 2016: 10 · 2015: 10 · 2014: 10 · 2013: 13 · 2012: 7
FWCI
6.56
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion, cc-by-nc-nd)
Funders
Michael Smith Health Research BC
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
quetiapine, long-term antipsychotic treatment, first-episode psychosis, relapse prevention, antipsychotic discontinuation, adverse drug reactions, early psychosis
MeSH terms
Quetiapine Fumarate, Dibenzothiazepines, Double-Blind Method, Female, Humans, Male, Psychotic Disorders, Recurrence, Time Factors, Antipsychotic Agents, Treatment Outcome

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