Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

Richard Whale; Michael Harris; Gail Kavanagh; Vijitha Wickramasinghe; Christopher I Jones; Steven Marwaha; Ketan Jethwa; Nirmalan Ayadurai; Andrew Thompson

doi:10.1192/bjpo.bp.116.002766

Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

Richard Whale, Michael Harris, Gail Kavanagh, Vijitha Wickramasinghe, Christopher I Jones, Steven Marwaha, Ketan Jethwa, Nirmalan Ayadurai, Andrew Thompson

Life and Environmental Sciences

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Abstract

BACKGROUND: One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).

AIMS: To investigate the effectiveness of commonly used antipsychotic medications in FEP.

METHOD: A retrospective cohort study of naturalistic treatment of patients (N=460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.

RESULTS: Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.

CONCLUSIONS: Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.

DECLARATION OF INTEREST: R.W., A.T. and S.M. have received research grant, speaker honoraria and conference attendance funding from all companies marketing antipsychotics.

COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Original language	English
Pages (from-to)	323-329
Number of pages	7
Journal	British Journal of Psychiatry Open
Volume	2
Issue number	5
DOIs	https://doi.org/10.1192/bjpo.bp.116.002766
Publication status	Published - Sept 2016

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title = "Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study",

abstract = "BACKGROUND: One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).AIMS: To investigate the effectiveness of commonly used antipsychotic medications in FEP.METHOD: A retrospective cohort study of naturalistic treatment of patients (N=460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.RESULTS: Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.CONCLUSIONS: Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.DECLARATION OF INTEREST: R.W., A.T. and S.M. have received research grant, speaker honoraria and conference attendance funding from all companies marketing antipsychotics.COPYRIGHT AND USAGE: {\textcopyright} The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.",

author = "Richard Whale and Michael Harris and Gail Kavanagh and Vijitha Wickramasinghe and Jones, {Christopher I} and Steven Marwaha and Ketan Jethwa and Nirmalan Ayadurai and Andrew Thompson",

year = "2016",

month = sep,

doi = "10.1192/bjpo.bp.116.002766",

language = "English",

volume = "2",

pages = "323--329",

journal = "British Journal of Psychiatry Open",

issn = "2056-4724",

publisher = "Royal College of Psychiatrists",

number = "5",

}

TY - JOUR

T1 - Effectiveness of antipsychotics used in first-episode psychosis

T2 - a naturalistic cohort study

AU - Whale, Richard

AU - Harris, Michael

AU - Kavanagh, Gail

AU - Wickramasinghe, Vijitha

AU - Jones, Christopher I

AU - Marwaha, Steven

AU - Jethwa, Ketan

AU - Ayadurai, Nirmalan

AU - Thompson, Andrew

PY - 2016/9

Y1 - 2016/9

N2 - BACKGROUND: One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).AIMS: To investigate the effectiveness of commonly used antipsychotic medications in FEP.METHOD: A retrospective cohort study of naturalistic treatment of patients (N=460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.RESULTS: Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.CONCLUSIONS: Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.DECLARATION OF INTEREST: R.W., A.T. and S.M. have received research grant, speaker honoraria and conference attendance funding from all companies marketing antipsychotics.COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

AB - BACKGROUND: One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).AIMS: To investigate the effectiveness of commonly used antipsychotic medications in FEP.METHOD: A retrospective cohort study of naturalistic treatment of patients (N=460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.RESULTS: Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.CONCLUSIONS: Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.DECLARATION OF INTEREST: R.W., A.T. and S.M. have received research grant, speaker honoraria and conference attendance funding from all companies marketing antipsychotics.COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

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DO - 10.1192/bjpo.bp.116.002766

M3 - Article

C2 - 27733935

SN - 2056-4724

VL - 2

SP - 323

EP - 329

JO - British Journal of Psychiatry Open

JF - British Journal of Psychiatry Open

IS - 5

ER -

Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

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