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Article: Long-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial

TitleLong-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial
Authors
Issue Date2018
PublisherThe Lancet Publishing Group. The Journal's web site is located at http://www.thelancet.com/journals/lanpsy/issues
Citation
The Lancet Psychiatry, 2018, v. 5 n. 5, p. 432-442 How to Cite?
AbstractBackground: The long-term consequences of discontinuing antipsychotic medication after successful treatment of first-episode psychosis are not well studied. We assess the relation between early maintenance therapy decisions in first-episode psychosis and the subsequent clinical outcome at 10 years. Methods: This is a 10 year follow-up study, spanning Sept 5, 2003, to Dec 30, 2014, of a randomised, double-blind trial in seven centres in Hong Kong in which 178 patients with first-episode psychosis with full positive symptom resolution after at least 1 year of antipsychotic treatment were given maintenance treatment (n=89; oral quetiapine 400 mg daily) or early treatment discontinuation (n=89; placebo) for 12 months. After the trial, patients received naturalistic treatment. Overall this cohort of patients will have received about 3 years of treatment before entering the follow-up phase of the study: about 2 years of maintenance treatment before study entry and 1 year of treatment in the trial. The primary outcome of this follow-up was the proportion of patients in each group (including those for whom direct follow-up was not available) with good or poor long-term clinical outcomes at 10 years, with poor outcome defined as a composite of persistent psychotic symptoms, a requirement for clozapine treatment, or death by suicide. The randomised trial was registered with ClinicalTrials.gov, number NCT00334035, and the follow-up study was registered with ClinicalTrials.gov, number NCT01926340. Findings: Poor 10 year clinical outcome occurred in 35 (39%) of 89 patients in the discontinuation group and 19 (21%) of 89 patients in the maintenance treatment group (risk ratio 1·84, 95% CI 1·15–2·96; p=0·012). Suicide was the only serious adverse event that occurred in the follow-up phase (four [4%] patients in the early discontinuation group vs two [2%] in the maintenance group). Interpretation: In patients with first-episode psychosis with a full initial response to treatment, medication continuation for at least the first 3 years after starting treatment decreases the risk of relapse and poor long-term clinical outcome. Funding: Food and Health Bureau, Research Grants Council of Hong Kong, and AstraZeneca.
Persistent Identifierhttp://hdl.handle.net/10722/254741
ISSN
2015 SCImago Journal Rankings: 1.974
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorHui, CLM-
dc.contributor.authorHoner, WG-
dc.contributor.authorLee, EHM-
dc.contributor.authorChang, WC-
dc.contributor.authorChan, SKW-
dc.contributor.authorChen, ESM-
dc.contributor.authorPang, EPF-
dc.contributor.authorLui, SSY-
dc.contributor.authorChung, DWS-
dc.contributor.authorYeung, WS-
dc.contributor.authorNg, RMK-
dc.contributor.authorLo, WTL-
dc.contributor.authorJones, PB-
dc.contributor.authorSham, PC-
dc.contributor.authorChen, EYH-
dc.date.accessioned2018-06-21T01:05:48Z-
dc.date.available2018-06-21T01:05:48Z-
dc.date.issued2018-
dc.identifier.citationThe Lancet Psychiatry, 2018, v. 5 n. 5, p. 432-442-
dc.identifier.issn2215-0366-
dc.identifier.urihttp://hdl.handle.net/10722/254741-
dc.description.abstractBackground: The long-term consequences of discontinuing antipsychotic medication after successful treatment of first-episode psychosis are not well studied. We assess the relation between early maintenance therapy decisions in first-episode psychosis and the subsequent clinical outcome at 10 years. Methods: This is a 10 year follow-up study, spanning Sept 5, 2003, to Dec 30, 2014, of a randomised, double-blind trial in seven centres in Hong Kong in which 178 patients with first-episode psychosis with full positive symptom resolution after at least 1 year of antipsychotic treatment were given maintenance treatment (n=89; oral quetiapine 400 mg daily) or early treatment discontinuation (n=89; placebo) for 12 months. After the trial, patients received naturalistic treatment. Overall this cohort of patients will have received about 3 years of treatment before entering the follow-up phase of the study: about 2 years of maintenance treatment before study entry and 1 year of treatment in the trial. The primary outcome of this follow-up was the proportion of patients in each group (including those for whom direct follow-up was not available) with good or poor long-term clinical outcomes at 10 years, with poor outcome defined as a composite of persistent psychotic symptoms, a requirement for clozapine treatment, or death by suicide. The randomised trial was registered with ClinicalTrials.gov, number NCT00334035, and the follow-up study was registered with ClinicalTrials.gov, number NCT01926340. Findings: Poor 10 year clinical outcome occurred in 35 (39%) of 89 patients in the discontinuation group and 19 (21%) of 89 patients in the maintenance treatment group (risk ratio 1·84, 95% CI 1·15–2·96; p=0·012). Suicide was the only serious adverse event that occurred in the follow-up phase (four [4%] patients in the early discontinuation group vs two [2%] in the maintenance group). Interpretation: In patients with first-episode psychosis with a full initial response to treatment, medication continuation for at least the first 3 years after starting treatment decreases the risk of relapse and poor long-term clinical outcome. Funding: Food and Health Bureau, Research Grants Council of Hong Kong, and AstraZeneca.-
dc.languageeng-
dc.publisherThe Lancet Publishing Group. The Journal's web site is located at http://www.thelancet.com/journals/lanpsy/issues-
dc.relation.ispartofThe Lancet Psychiatry-
dc.titleLong-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial-
dc.typeArticle-
dc.identifier.emailHui, CLM: christyh@hku.hk-
dc.identifier.emailLee, EHM: edwinlhm@hku.hk-
dc.identifier.emailChang, WC: changwc@hku.hk-
dc.identifier.emailChan, SKW: kwsherry@hku.hk-
dc.identifier.emailLui, SSY: lsy570@hku.hk-
dc.identifier.emailSham, PC: pcsham@hku.hk-
dc.identifier.emailChen, EYH: eyhchen@hku.hk-
dc.identifier.authorityHui, CLM=rp01993-
dc.identifier.authorityLee, EHM=rp01575-
dc.identifier.authorityChang, WC=rp01465-
dc.identifier.authorityChan, SKW=rp00539-
dc.identifier.authorityLui, SSY=rp02747-
dc.identifier.authoritySham, PC=rp00459-
dc.identifier.authorityChen, EYH=rp00392-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S2215-0366(18)30090-7-
dc.identifier.pmid29551618-
dc.identifier.scopuseid_2-s2.0-85043788517-
dc.identifier.hkuros285344-
dc.identifier.volume5-
dc.identifier.issue5-
dc.identifier.spage432-
dc.identifier.epage442-
dc.identifier.isiWOS:000431004000023-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl2215-0366-

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