Antipsychotic drugs lower the risk of relapse in patients with schizophrenia by more than half (60%), according to an analysis of 50 years of evidence published Online First in The Lancet. Patients who receive antipsychotics are also significantly less likely to be hospitalised, behave aggressively, and might have a better quality than those not taking medication.
Schizophrenia is a debilitating, often lifelong disease that has a lifetime prevalence of about 1%. Antipsychotic drugs are the mainstay of treatment for patients with schizophrenia, but they can cause serious side effects and it is therefore important to ensure patients are still benefiting from ongoing drug treatment.
Antipsychotic drugs are also very expensive, costing an estimated $18.5 billion worldwide in 2010. Moreover, since schizophrenia's main cost is hospitalisation due to relapse (which is very common among patients with schizophrenia), relapse prevention has important implications.
In this systematic review and meta-analysis, Stefan Leucht from Technische Universität München, Munich, Germany and colleagues analysed results of 116 reports from 65 trials published between 1959 and 2011, involving nearly 6500 patients with schizophrenia.
Overall, they found that antipsychotic drugs significantly reduced relapse rates at one year compared with placebo (27% vs 64%).
The analysis also showed that fewer patients given antipsychotic drugs than placebo were readmitted to hospital (10% vs 26%), although less than a third of relapsed patients needed to be admitted.
Limited evidence (from 5 studies) also suggested that fewer patients given antipsychotic drugs behaved aggressively, and findings from three studies indicated that quality of life was better among patients on antipsychotic maintenance treatment.
However, patients given antipsychotics experienced more adverse side effects including movement disorders (16% vs 9%), sedation (13% vs 9%), and weight gain (10% vs 6%) compared with those given placebo.
The authors say: "We have established that antipsychotic maintenance treatment substantially reduces relapse risk in all patients with schizophrenia for up to 2 years of follow-up. The effect was robust in important subgroups such as patients who had only one episode, those in remission, and irrespective of abrupt or gradual withdrawal of treatment or between first-generation or second-generation drugs, but the drugs seemed to lose their effectiveness with time."*
They conclude: "Future studies should focus on outcomes of social participation and long-term morbidity and mortality of these drugs."
In an accompanying Comment, Jim van Os from Maastricht University Medical Centre, Netherlands and Oliver Howes from King's College London say: "Although the evidence for antipsychotic drugs seems robust, several important issues remain. We do not know whether patients prefer drugs to placebo, and to what degree treatment affects social participation."
Moreover, they add: "Although antipsychotic drugs might reduce relapse of psychosis, the cost-benefit analysis for long-term use is imprecise at best, and no evidence that other, more disabling, domains of psychopathology such as cognitive alterations or motivational impairment are similarly alleviated is available."
Professor Stefan Leucht, Technische Universität München, Munich, Germany.
T) +49 89 4140 4249 E) Stefan.leucht@lrz.tum.de
Dr Jim van Os, Maastricht University Medical Centre, Maastricht, Netherlands.
T) +31 43 3875 443 E) j.vanos@maastrichtuniversity.nl
Notes to Editors:
This Article is a copublication with a Cochrane Review (Cochrane Database Syst Rev 2012; 5: CD008016).
*Quote direct from authors and cannot be found in text of Article.
Journal
The Lancet