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Clinical and Translational Science
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Clinical and Translational Science
Article
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Persistence of Antipsychotic Use After Clozapine Discontinuation: A Real‐World Study Across Antipsychotics

A Real-World Study Across Antipsychotics
Authors: Antti Tanskanen; Antti Tanskanen; Antti Tanskanen; Jens H. J. Bos; Heidi Taipale; Heidi Taipale; Jari Tiihonen; +7 Authors

Persistence of Antipsychotic Use After Clozapine Discontinuation: A Real‐World Study Across Antipsychotics

Abstract

Although clozapine treatment is often discontinued due to limited efficacy or low tolerability, there is a lack of guidelines and evidence on treatment options after discontinuation of clozapine in patients with schizophrenia. Persistence has proven to be an adequate indicator for treatment effectiveness in patients with schizophrenia. The aim of this study was, therefore, to compare persistence of antipsychotic use between antipsychotic treatment options in patients after stopping clozapine treatment. Registry data from a prescription database representative of the Dutch population (1996–2017) was collected to investigate persistence in patients with schizophrenia who had been using clozapine for ≥ 90 days. Persistence with antipsychotics after clozapine discontinuation was analyzed using Cox‐proportional hazard regression models. Our study population consisted of 321 participants, of whom 138 re‐initiated clozapine and 183 started some other antipsychotic in the year after clozapine discontinuation (N = 518 antipsychotic use periods, N = 9,178 months). Second‐generation antipsychotics (SGAs) as a group were associated with better persistence compared to first‐generation antipsychotics (adjusted hazard ratio (aHR), 0.73; 95% confidence interval (CI) 0.57–0.93; P = 0.011). Compared with other antipsychotics, the following oral monotherapy antipsychotics were associated with significantly better persistence: restarting clozapine (aHR 0.48; 95% CI 0.32–0.71; P < 0.001) and switching to risperidone (aHR 0.52; 95% CI 0.32–0.84; P = 0.008) or olanzapine (aHR 0.55; 95% CI 0.35–0.87; P = 0.010). Sensitivity analyses confirmed the results. In conclusion, oral SGAs are associated with better persistence than alternative antipsychotic treatment options in patients discontinuing clozapine for undefined reasons. Especially clozapine (except in those with previous serious adverse reactions to clozapine), olanzapine and risperidone should be considered as oral monotherapy for these patients.

Keywords

Adult, Male, General Biochemistry,Genetics and Molecular Biology, Administration, Oral, Pharmacology, Toxicology and Pharmaceutics(all), ADHERENCE, Journal Article, DRUGS, Humans, COHORT, Registries, 1ST-GENERATION ANTIPSYCHOTICS, Clozapine, Netherlands, Retrospective Studies, Assessment of Medication Adherence, TREATMENT-RESISTANT SCHIZOPHRENIA, Drug Substitution, General Neuroscience, Research, Middle Aged, EFFICACY, Risperidone, RECHALLENGE, Treatment Outcome, DATABASE IADB.NL, Olanzapine, Schizophrenia, TOLERABILITY, Drug Therapy, Combination, Female, Antipsychotic Agents, Follow-Up Studies

  • BIP!
    Impact byBIP!
    citations
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    9
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
9
Top 10%
Average
Top 10%
Green
gold