Background

Many patients with schizophrenia discontinue antipsychotic medication, frequently with adverse outcomes. Although different antipsychotic formulations are associated with different times to discontinuation, not much is known about discontinuation rates with oral-weekly formulations. Such a formulation of penfluridol is available in both the Netherlands and several other countries.

Objectives

We aimed to investigate the impact of antipsychotic formulations on time to discontinuation, especially the oral-weekly formulation.

Methods

In a large, registry-based, retrospective cohort study from 1 January 2013 to 31 December 2016, we determined the time to medication discontinuation during the follow-up period with antipsychotic formulations, including oral-daily, oral-weekly, depot, or a combination of these. Patients with schizophrenia aged between 18 and 69 years were included and stratified according to the duration of recent antipsychotic use (taking the same formulation for ≤ 60 days or > 60 days before follow-up: short-term or long-term recent antipsychotic use). Medication discontinuation was defined as discontinuation of current antipsychotic formulation.

Results

Overall, 8257 patients were included for analyses, with 80% of patients discontinuing antipsychotic medication. Time to discontinuation was longer in those with long-term recent antipsychotic use before the follow-up period and longest for oral-daily formulations. Patterns for discontinuation of oral-weekly and depot formulations were similar, regardless of the duration of recent antipsychotic use before follow-up. More prior discontinuations were associated with shorter time to discontinuation.

Conclusions

Time to discontinuation differed considerably between formulations. The duration of recent antipsychotic use was a strong predictor of time to discontinuation. While oral-daily formulations had the longest time to discontinuation in the long-term recent antipsychotic use group, discontinuation trends were similar for oral-weekly and depot formulations. An oral-weekly formulation, whose administration route is noninvasive, might therefore be considered an alternative to depot formulations.

中文翻译：

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抗精神病药物制剂对精神分裂症患者停药时间的影响：一项基于荷兰登记的回顾性队列研究

背景

许多精神分裂症患者停用抗精神病药物，经常出现不良后果。尽管不同的抗精神病制剂与不同的停药时间有关，但对于每周口服制剂的停药率知之甚少。这种五氟利多制剂在荷兰和其他几个国家都可以买到。

目标

我们旨在调查抗精神病药物制剂对停药时间的影响，尤其是每周口服制剂。

方法

在 2013 年 1 月 1 日至 2016 年 12 月 31 日的一项大型、基于注册的回顾性队列研究中，我们确定了在随访期间使用抗精神病制剂停药的时间，包括每日口服、每周口服、长效制剂或这些的组合。纳入 18 至 69 岁的精神分裂症患者，并根据最近使用抗精神病药物的持续时间进行分层（在随访前服用相同制剂 ≤ 60 天或 > 60 天：近期或长期近期使用抗精神病药物） . 停药定义为停用当前的抗精神病药物制剂。

结果

总体而言，8257 名患者被纳入分析，其中 80% 的患者停用抗精神病药物。在随访期之前长期近期使用抗精神病药物的患者停药时间较长，而每日口服制剂的停药时间最长。无论随访前最近使用抗精神病药物的时间长短，停用每周口服和长效制剂的模式相似。更多的先前停药与更短的停药时间相关。

结论

不同配方的停药时间差异很大。最近使用抗精神病药物的持续时间是停药时间的有力预测指标。虽然在长期近期抗精神病药物使用组中，每日口服制剂的停药时间最长，但每周口服和长效制剂的停药趋势相似。因此，每周口服一次的制剂，其给药途径是无创的，因此可能被认为是长效制剂的替代品。