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.

Autor:	Hui CLM; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China. Electronic address: christy@lmhui.com., Honer WG; Department of Psychiatry, University of British Columbia, Canada., Lee EHM; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China., Chang WC; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China., Chan SKW; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China., Chen ESM; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China., Pang EPF; Department of Psychiatry, United Christian Hospital, Hong Kong Special Administrative Region, China., Lui SSY; Department of Psychiatry, Castle Peak Hospital, Hong Kong Special Administrative Region, China., Chung DWS; Department of Psychiatry, Tai Po Hospital, Hong Kong Special Administrative Region, China., Yeung WS; Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China., Ng RMK; Department of Psychiatry, Kowloon Hospital, Hong Kong Special Administrative Region, China., Lo WTL; Department of Psychiatry, Kwai Chung Hospital, Hong Kong Special Administrative Region, China., Jones PB; Department of Psychiatry, University of Cambridge, Cambridge, UK., Sham P; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China; Centre for Genomic Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China., Chen EYH; Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China.
Jazyk:	angličtina
Zdroj:	The lancet. Psychiatry [Lancet Psychiatry] 2018 May; Vol. 5 (5), pp. 432-442. Date of Electronic Publication: 2018 Mar 15.
DOI:	10.1016/S2215-0366(18)30090-7
Abstrakt:	Background: 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. (Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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