Sunday, September 25, 2022

Switching antipsychotics effective in preventing relapses in schizophrenia, study finds

The researchers conclude that medical guidelines need to be updated.

The researchers evaluated the effect of different antipsychotic treatment strategies on the risk of relapse. Photo: Shutterstock.

A group of researchers has revealed some improvements in antipsychotic maintenance strategies and thus preventing relapse in clinically stable schizophrenia.

These results, according to the researchers’ hypothesis, contradict what is said in the current literature, since switching to another antipsychotic was as effective as continuing with an antipsychotic. standard dose antipsychotic.

Switching to another antipsychotic “does not increase the risk of relapse. This result was not expected, as previous literature suggested otherwise,” Giovanni Ostuzzi, MD, Università degli Studi di Verona, Verona, told Medscape Medical News. Italy.

“On the other hand, reducing the dose below the standard range used in the acute phase leads to a tangible risk of relapse and should be limited to selected cases, for example, those where the risk of abandoning treatment altogether is particularly high,” said Dr. Ostuzzi.

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“These results should inform evidence-based recommendations, considering that clinical practice for relapse prevention is still heterogeneous and often guided only by clinical common sense,” he added.

The study was published in the journal The Lancet Psychiatry. In this sense, the authors emphasize that it is necessary to update the clinical guidelines

The researchers evaluated the effect of different antipsychotic treatment strategies on the risk of relapse in a network meta-analysis of 98 randomized controlled trials involving nearly 14,000 patients.

Compared with antipsychotic discontinuation, all continuation strategies were effective in preventing relapses.

The risk of relapse was greatly reduced and, similarly, continuing treatment standard dose antipsychotic switching to a different antipsychotic (relative risk [RR]: 0.37 and 0.44, respectively), the researchers found.

Both strategies outperformed the substandard antipsychotic dose reduction strategy (RR: 0.68), which was inferior to the other two strategies.

For every three patients who continue on a standard-dose antipsychotic, one additional patient will avoid relapse, compared to discontinuing the antipsychotic, “which can be considered a large effect size based on commonly used thresholds and outcomes.” of trials”. acute schizophrenia,” the researchers wrote.

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The required number of patients to treat increased slightly by about 3.5% for patients who switched from antipsychotic treatment, which “is still considered a large effect size,” they noted.

“Currently, most psychiatrists are aware of the benefits of continuing antipsychotics in clinically stable individuals. However, they may face the need to change their ongoing treatment strategy, often due to side effects, poor adherence to treatment, or both,” noted Dr. Ostuzzi.

“Our findings support updating clinical practice guidelines to recognize that switching to another antipsychotic during maintenance treatment may be as effective as continuing antipsychotics at the standard dose, while dose reduction below the recommended dose should be limited to selected cases,” the researchers said. .

Source consulted here.

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