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Antipsychotic patterns of use in patients with schizophrenia: polypharmacy versus monotherapy.

Fisher MD, Reilly K, Isenberg K, Villa KF - BMC Psychiatry (2014)

Bottom Line: Age and polypharmacy were independent predictors of treatment duration and discontinuation prior to one year.Discontinuation was higher in the polypharmacy group.Age and polypharmacy were significant predictors of treatment discontinuation.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The objective of this study was to characterize real-world treatment patterns in the prescription of antipsychotic polypharmacy (≥ 2 concurrent antipsychotics) compared with antipsychotic monotherapy for patients with schizophrenia.

Methods: This study was a retrospective claims-based analysis of patients (aged 13-64 years) with schizophrenia belonging to an employer-based health plan. Duration of therapy was measured as the number of treatment days over one year following the initial date of antipsychotic therapy. Discontinuation was defined as a 90-day gap in antipsychotic treatment (or in at least one antipsychotic for the polypharmacy group). Logistic regression analyses were used to predict discontinuation within one year. Ordinary Least Squares (OLS) regressions were used to predict duration of therapy (by type of therapy) when controlling for gender, region, number of somatic and psychiatric comorbidities, Deyo-Charlson comorbidity score, and number of psychiatric and somatic medications.

Results: Of the 4,156 patients, 3,188 received monotherapy and 968 received polypharmacy. Mean age was 40 years (37.8 years for polypharmacy vs 40.3 years for monotherapy, p < 0.001). Within one year, 77% of the polypharmacy group and 54% of the monotherapy group discontinued treatment. The average duration of therapy was 163 [SD = 143] days in the polypharmacy group vs 253 [SD = 147] days in the monotherapy group. In both cohorts, patients <25 years had a higher frequency of discontinuations than those ≥ 26 years. Age and polypharmacy were independent predictors of treatment duration and discontinuation prior to one year.

Conclusions: One quarter of patients with schizophrenia received antipsychotic polypharmacy. Discontinuation was higher in the polypharmacy group. Age and polypharmacy were significant predictors of treatment discontinuation.

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Percentage of patients, by age, who discontinuedawithin one year follow-up.aFor polypharmacy patients, discontinuation was defined as a 90-day treatment gap in at least 1 index antipsychotic.
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Fig1: Percentage of patients, by age, who discontinuedawithin one year follow-up.aFor polypharmacy patients, discontinuation was defined as a 90-day treatment gap in at least 1 index antipsychotic.

Mentions: A higher proportion of patients in the polypharmacy cohort discontinued index treatment prior to the end of the one year follow-up period compared with the monotherapy group (Figure 1). Overall, 77% of those in the polypharmacy group discontinued at least one of their index antipsychotics within one year, whereas 54% of those in the monotherapy group discontinued their index medication within one year. A greater proportion of patients in the polypharmacy group discontinued therapy compared with those receiving monotherapy when all age groups were considered. In both the monotherapy and polypharmacy cohorts, patients younger than 25 years had a higher frequency of treatment discontinuation prior to one year than those 26 years and older (Figure 1).Figure 1


Antipsychotic patterns of use in patients with schizophrenia: polypharmacy versus monotherapy.

Fisher MD, Reilly K, Isenberg K, Villa KF - BMC Psychiatry (2014)

Percentage of patients, by age, who discontinuedawithin one year follow-up.aFor polypharmacy patients, discontinuation was defined as a 90-day treatment gap in at least 1 index antipsychotic.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4264319&req=5

Fig1: Percentage of patients, by age, who discontinuedawithin one year follow-up.aFor polypharmacy patients, discontinuation was defined as a 90-day treatment gap in at least 1 index antipsychotic.
Mentions: A higher proportion of patients in the polypharmacy cohort discontinued index treatment prior to the end of the one year follow-up period compared with the monotherapy group (Figure 1). Overall, 77% of those in the polypharmacy group discontinued at least one of their index antipsychotics within one year, whereas 54% of those in the monotherapy group discontinued their index medication within one year. A greater proportion of patients in the polypharmacy group discontinued therapy compared with those receiving monotherapy when all age groups were considered. In both the monotherapy and polypharmacy cohorts, patients younger than 25 years had a higher frequency of treatment discontinuation prior to one year than those 26 years and older (Figure 1).Figure 1

Bottom Line: Age and polypharmacy were independent predictors of treatment duration and discontinuation prior to one year.Discontinuation was higher in the polypharmacy group.Age and polypharmacy were significant predictors of treatment discontinuation.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The objective of this study was to characterize real-world treatment patterns in the prescription of antipsychotic polypharmacy (≥ 2 concurrent antipsychotics) compared with antipsychotic monotherapy for patients with schizophrenia.

Methods: This study was a retrospective claims-based analysis of patients (aged 13-64 years) with schizophrenia belonging to an employer-based health plan. Duration of therapy was measured as the number of treatment days over one year following the initial date of antipsychotic therapy. Discontinuation was defined as a 90-day gap in antipsychotic treatment (or in at least one antipsychotic for the polypharmacy group). Logistic regression analyses were used to predict discontinuation within one year. Ordinary Least Squares (OLS) regressions were used to predict duration of therapy (by type of therapy) when controlling for gender, region, number of somatic and psychiatric comorbidities, Deyo-Charlson comorbidity score, and number of psychiatric and somatic medications.

Results: Of the 4,156 patients, 3,188 received monotherapy and 968 received polypharmacy. Mean age was 40 years (37.8 years for polypharmacy vs 40.3 years for monotherapy, p < 0.001). Within one year, 77% of the polypharmacy group and 54% of the monotherapy group discontinued treatment. The average duration of therapy was 163 [SD = 143] days in the polypharmacy group vs 253 [SD = 147] days in the monotherapy group. In both cohorts, patients <25 years had a higher frequency of discontinuations than those ≥ 26 years. Age and polypharmacy were independent predictors of treatment duration and discontinuation prior to one year.

Conclusions: One quarter of patients with schizophrenia received antipsychotic polypharmacy. Discontinuation was higher in the polypharmacy group. Age and polypharmacy were significant predictors of treatment discontinuation.

Show MeSH
Related in: MedlinePlus