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05-08-2013 | Mental health | Article

Intermittent antipsychotic therapy ‘not supported by evidence’

Abstract

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medwireNews: Intermittent antipsychotic therapy is less effective than continuous maintained therapy for preventing relapse in people with schizophrenia, conclude the authors of a Cochrane review.

“Until further evidence is available concerning the potential benefits or harms of intermittent treatment, managers, psychiatrists and policy makers should consider it an experimental therapy,” advises the Cochrane Schizophrenia Group led by Stephanie Sampson (University of Nottingham, UK).

The Group performed a literature review to assess the efficacy of intermittent medication use in people with schizophrenia. By using antipsychotic medication only during periods of incipient relapse or symptom exacerbation, the aim is to reduce the frequency of antipsychotic-induced side effects, explain Sampson et al writing in The Cochrane Library.

They identified 17 relevant randomized controlled trials that were conducted between 1961 and 2011 and included 2252 people with schizophrenia or schizophrenia-like psychoses.

Seven of the trials assessed long-term relapse rates in 436 patients. Meta-analysis showed that the risk for relapse was significantly higher for people who received intermittent drug treatment than for those on standard maintenance therapy, with a relative risk (RR) of 2.46.

Five trials examined long-term rates of hospitalization in 626 patients. Meta-analysis found that this outcome was also significantly more likely for people who received intermittent drug therapy rather than continuous maintenance treatment, with an RR of 1.65.

Interestingly, intermittent treatment was more effective than placebo for preventing relapse. In two trials assessing medium-term outcomes in 290 patients, the risk for relapse was significantly lower in people who received intermittent drug treatment rather than placebo, with a RR of 0.37. The same was true for a single trial assessing short-term outcomes in 89 patients, which found a RR of 0.22 for intermittent therapy versus placebo.

The frequency of tardive dyskinesia over medium- and long-term follow up did not differ significantly between patients taking intermittent and maintenance therapy, however.

While admitting that many of the trials included in their review were of poor quality, Sampson’s team concludes: “The results suggested that intermittent drug techniques do not play a preventative role for relapse or (re)hospitalisation when compared with maintenance therapy, and the assumption that intermittent antipsychotic treatment may minimise potential adverse effects associated with continuous, long-term antipsychotic treatment is far from being concluded.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Joanna Lyford, Senior medwireNews Reporter

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