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. 2020 Jan:215:8-16.
doi: 10.1016/j.schres.2019.09.013. Epub 2019 Nov 26.

Antipsychotic treatment in the maintenance phase of schizophrenia: An updated systematic review of the guidelines and algorithms

Yutaro Shimomura  1 , Yuhei Kikuchi  1 , Takefumi Suzuki  2 , Hiroyuki Uchida  3 , Masaru Mimura  1 , Hiroyoshi Takeuchi  4
Affiliations

Antipsychotic treatment in the maintenance phase of schizophrenia: An updated systematic review of the guidelines and algorithms

Yutaro Shimomura et al. Schizophr Res. 2020 Jan.

Abstract

Background: We updated our previous systematic review regarding clinical guidelines and algorithms on antipsychotic treatment in the maintenance phase of schizophrenia (doi: 10.1016/j.schres.2011.11.021) to incorporate and synthesize more recent findings to guide clinical practice.

Methods: We conducted a systematic literature search to identify clinical guidelines and algorithms describing antipsychotic treatment in the maintenance phase of schizophrenia using MEDLINE and Embase. We assessed overall quality of the guidelines/algorithms according to the AGREE II instrument and extracted information on treatment recommendations.

Results: We identified 20 guidelines/algorithms from various regions, including 11 updated or newly launched ones after the previous systematic review in 2012. All of the guidelines/algorithms satisfied a certain level of quality. Where mentioned, endorsements were sorted into "recommended", "partially recommended", or "not recommended". As for antipsychotic discontinuation strategy, a majority of guidelines/algorithms that mentioned this strategy did not recommend it for multiple-episode schizophrenia (N = 5/6). On the other hand, the guidelines/algorithms tended to shift from "not recommended" to "partially recommended" both for schizophrenia in general (N = 7/13, N = 7/8 for those published after 2013) and first-episode schizophrenia (N = 10/11, N = 7/7 for those published after 2013) regarding this strategy. All guidelines/algorithms (N = 9/9) converged to discourage antipsychotic intermittent/targeted strategy. Similar to antipsychotic discontinuation strategy, all of the updated or new guidelines/algorithms (N = 6/6) endorsed antipsychotic dose reduction/lower dose strategy.

Conclusion: Recent clinical guidelines and algorithms on antipsychotic maintenance treatment in schizophrenia shifted more toward a possibility of antipsychotic discontinuation and dose reduction/lower dose strategies. Nonetheless, clinicians need to contemplate on the risk-benefit balance of these strategies for individual patients.

Keywords: Algorithms; Antipsychotics; Guidelines; Maintenance; Schizophrenia.

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Conflict of interest statement

Declaration of competing interest Drs. Shimomura and Kikuchi have no conflicts of interest. Dr. Suzuki has received research grants from Eisai, Mochida, and Meiji Seika Pharma, and manuscript or speaker’s fees from Astellas Pharma, Eli Lilly, Elsevier, Janssen, Kyowa, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Novartis Pharma, Otsuka, Shionogi, Tsumura, Sumitomo Dainippon Pharma, Yoshitomiyakuhin, and Wiley. Dr. Uchida has received research grants from Eisai, Meiji Seika Pharma, Otsuka, and Sumitomo Dainippon Pharma, speaker’s fees from Eli Lilly, Meiji Seika Pharma, MSD, Otsuka, Pfizer, Sumitomo Dainippon Pharma, and Yoshitomiyakuhin, and advisory panel fees from Sumitomo Dainippon Pharma. Dr. Mimura has received research grants from Daiichi Sankyo, Eisai, Mitsubishi Tanabe Pharma, Pfizer, Shionogi, Takeda, and Tsumura, and speaker’s fees from Daiichi Sankyo, Eisai, Eli Lilly, Fujifilm RI Pharma, Janssen, Mochida, MSD, Nippon Chemipher, Novartis Pharma, Ono, Otsuka, Pfizer, Sumitomo Dainippon Pharma, Takeda, Tsumura, and Yoshitomiyakuhin. Dr. Takeuchi has received fellowship grants from Astellas Foundation for Research on Metabolic Disorders, the Canadian Institutes of Health Research (CIHR), Centre for Addiction and Mental Health (CAMH) Foundation, and the Japanese Society of Clinical Neuropsychopharmacology, speaker’s fees from Meiji Seika Pharma, Mochida, Otsuka, Sumitomo Dainippon Pharma, and Yoshitomiyakuhin, and manuscript fees from Sumitomo Dainippon Pharma.

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