Stopping antipsychotic drugs early has long-term pay-off
medwireNews: Patients with first-episode psychosis are much more likely to achieve functional recovery in the long term if they reduce or discontinue antipsychotic drugs soon after symptomatic remission, rather than staying on maintenance treatment, a study shows.
Previous short-term results from the randomized trial, reported after 18 months of follow up, showed that patients assigned to reduce or discontinue their antipsychotic medication had similar functional outcomes to patients assigned to maintenance therapy, and were twice as likely to have a relapse.
This was in line with "conventional wisdom," say Patrick McGorry and colleagues, from the University of Melbourne in Australia, writing in an editorial that accompanies the study in JAMA Psychiatry.
But despite the increased relapse rate, after 7 years of follow up involving 103 of the original 128 patients, 40.4% of those who had reduced or discontinued their medication had achieved recovery, defined as the composite of symptomatic remission, assessed on the Positive and Negative Syndrome Scale, and functional remission, assessed on the Groningen Social Disability Schedule.
This was more than double the rate among patients who remained on maintenance therapy, 17.6% of whom achieved recovery, report Lex Wunderink (Friesland Mental Health Services, Leeuwarden, the Netherlands) and colleagues. In logistic regression analysis, this equated to a 3.49-fold increased likelihood for recovery among patients who reduced or discontinued medication.
The difference in recovery rates was not driven by symptomatic remission, which occurred in about two-thirds of both groups, but by functional remission, which was achieved by 46.2% of the reduced/discontinued medication group compared with 19.6% of the maintenance therapy group.
The increased relapse rate in the group that reduced/discontinued medication persisted only for the first 3 years, during which time the majority of relapses occurred. McGorry et al comment that, previously, "although relapses were appropriately seen as a genuine threat to recovery, all too often, in research and clinical practice, prevention of relapse became an end in itself rather than an intermediate goal on the path to recovery."
The editorialists believe that the current findings "pose a challenge to linear thinking in relationship to relapse," by appearing to "put relapse in perspective." They say: "Modest exacerbations of symptoms, which are more common in the 3 to 5 years after diagnosis, may be a price worth paying for better longer-term functional recovery."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter