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Randomized Controlled Trial
. 2023 Nov;53(15):7078-7086.
doi: 10.1017/S0033291723000429. Epub 2023 Mar 10.

Guided antipsychotic reduction to reach minimum effective dose (GARMED) in patients with remitted psychosis: a 2-year randomized controlled trial with a naturalistic cohort

Chen-Chung Liu  1   2 , Ming H Hsieh  1   2 , Yi-Ling Chien  1   2 , Chih-Min Liu  1   2 , Yi-Ting Lin  1   2 , Tzung-Jeng Hwang  1   2 , Hai-Gwo Hwu  1   2
Affiliations
Randomized Controlled Trial

Guided antipsychotic reduction to reach minimum effective dose (GARMED) in patients with remitted psychosis: a 2-year randomized controlled trial with a naturalistic cohort

Chen-Chung Liu et al. Psychol Med. 2023 Nov.

Abstract

Background: Patients with remitted psychosis face a dilemma between the wish to discontinue antipsychotics and the risk of relapse. We test if an operationalized guided-dose-reduction algorithm can help reach a lower effective dose without increased risks of relapse.

Methods: A 2-year open-label randomized prospective comparative cohort trial from Aug 2017 to Sep 2022. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomized 2:1 into guided dose reduction group (GDR) v. maintenance treatment group (MT1), together with a group of naturalistic maintenance controls (MT2). We observed if the relapse rates would be different between 3 groups, to what extent the dose could be reduced, and if GDR patients could have improved functioning and quality of life.

Results: A total of 96 patients, comprised 51, 24, and 21 patients in GDR, MT1, and MT2 groups, respectively. During follow-up, 14 patients (14.6%) relapsed, including 6, 4, and 4 from GDR, MT1, and MT2, statistically no difference between groups. In total, 74.5% of GDR patients could stay well under a lower dose, including 18 patients (35.3%) conducting 4 consecutive dose-tapering and staying well after reducing 58.5% of their baseline dose. The GDR group exhibited improved clinical outcomes and endorsed better quality of life.

Conclusions: GDR is a feasible approach as the majority of patients had a chance to taper antipsychotics to certain extents. Still, 25.5% of GDR patients could not successfully decrease any dose, including 11.8% experienced relapse, a risk comparable to their maintenance counterparts.

Keywords: Antipsychotics; functioning; minimum effective dose; remission; tapering.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in relation to the subject of this study.

Figures

Fig. 1.
Fig. 1.
Diagram of trial flow chart.
Fig. 2.
Fig. 2.
Kaplan-Meier survival estimates of proportions of patients who remained in remission during follow-up. The long dash-dot line represents the guided dose reduction group (GDR), the dashed line represents the Maintenance Group 1 (MT1), and the solid line represents the naturalistic observational comparison group (MT2).
See this image and copyright information in PMC

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