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Randomized Controlled Trial
. 2011 Jul;168(7):702-8.
doi: 10.1176/appi.ajp.2011.10060908. Epub 2011 May 2.

Effectiveness of switching from antipsychotic polypharmacy to monotherapy

Susan M Essock  1 , Nina R Schooler, T Scott Stroup, Joseph P McEvoy, Ingrid Rojas, Carlos Jackson, Nancy H Covell; Schizophrenia Trials Network
Collaborators, Affiliations
Randomized Controlled Trial

Effectiveness of switching from antipsychotic polypharmacy to monotherapy

Susan M Essock et al. Am J Psychiatry. 2011 Jul.

Abstract

Objective: This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy.

Method: Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time.

Results: Patients assigned to switch to monotherapy had shorter times to all-cause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight.

Conclusions: Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.

Trial registration: ClinicalTrials.gov NCT00044655.

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Figures

FIGURE 1
FIGURE 1. Time to Medication Change for Any Reasona
a Kaplan-Meier Mantel-Cox X2(1)=4.55, p =.03. In Cox Regression analyses, Treatment Group remained significant above and beyond gender and race (Wald X2(1)=4.22, p =.04). Group identifiers note Ns at baseline.
FIGURE 2
FIGURE 2. Total PANSS Score Through Timea
a No significant Group by Time interaction (p=.71); Also no significant effects for Gender (p=.58), Race (Caucasian versus non-Caucasian, p=.63) or Time (p=.60). Group identifiers note Ns at baseline.
FIGURE 3
FIGURE 3. Difference in Body Mass Index Through Timea
a No Significant Group by Time interaction (z = −1.95, p = .05). Group identifiers note Ns at baseline.
See this image and copyright information in PMC

Comment in

References

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