Schizophrenia often requires long-term treatment with antipsychotic medication. This study aims to measure the continuity of antipsychotic treatment over the course of illness in schizophrenia, as well as factors involved in the interruption of treatment. For this, we followed up a national cohort of first-episode psychosis patients in Finland for up to 18 years. Stratified Cox proportional hazards regressions were conducted for “within-participant” risk of discontinuation of subsequent treatments compared to the first, and by specific antipsychotic compared to oral olanzapine, the most prescribed antipsychotic in this cohort. Adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated. Among 3343 participants followed up for a mean of 8 years (SD = 4.93), the median number of continuous treatment episodes was 6 (interquartile range [IQR] = 3–11) with a median duration of 11.4 months (IQR = 5.3–25.6). In the first year after diagnosis, the incidence rate of treatment discontinuation was 30.12 (95% CI = 29.89–30.35) events per 100 participant-years, decreasing to 8.90 (95% CI = 8.75–9.05) in the 10th year. The risk of discontinuation progressively decreased over successive treatment episodes (aHR = 0.30; 95% CI = 0.20–0.46 for episodes after the 15th compared to the first). Individuals were 67% less likely to interrupt treatment with long-acting injectable than oral antipsychotics (aHR = 0.33; 95% CI = 0.27–0.41). Treatment for schizophrenia over the long term is often characterized by recurrent cycles of interruptions and reintroductions of antipsychotic medication, which is typically not recommended by management guidelines. Greater utilization of long-acting injectable formulations earlier in the course of illness may facilitate the continuity of antipsychotic treatment in schizophrenia.

中文翻译：

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精神分裂症抗精神病药物治疗的长期连续性：一项全国性研究

精神分裂症通常需要用抗精神病药物进行长期治疗。本研究旨在衡量精神分裂症病程中抗精神病药物治疗的连续性，以及治疗中断的相关因素。为此，我们对芬兰首发精神病患者的全国队列进行了长达 18 年的随访。与第一次相比，对后续治疗中止的“参与者内部”风险进行分层 Cox 比例风险回归，并将特定抗精神病药物与口服奥氮平（该队列中处方最多的抗精神病药物）进行比较。计算了调整后的风险比 (aHR) 和 95% 置信区间 (95% CI)。在 3343 名参与者中，平均随访 8 年（SD = 4.93），连续治疗发作的中位数为 6 次（四分位距 [IQR] = 3-11），中位持续时间为 11.4 个月（IQR = 5.3-25.6）。在诊断后的第一年，治疗中断的发生率为每 100 个参与者年 30.12 (95% CI = 29.89–30.35) 事件，在第 10 年降至 8.90 (95% CI = 8.75–9.05)。随着连续的治疗发作，停药的风险逐渐降低（aHR = 0.30；与第一次相比，第 15 次之后的发作的 95% CI = 0.20-0.46）。与口服抗精神病药相比，个体中断长效注射剂治疗的可能性低 67%（aHR = 0.33；95% CI = 0.27-0.41）。精神分裂症的长期治疗通常以反复中断和重新引入抗精神病药物为特征，管理指南通常不建议这样做。在病程早期更多地使用长效注射剂可能有助于精神分裂症抗精神病药物治疗的连续性。