A literature review published in Lancet Psychiatry supports recommendations for maintenance treatment or for switching antipsychotic medication to prevent relapse in people with chronic psychosis. Reducing medication below standard dose was associated with higher risk of relapse, the researchers found.
While continuing treatment is recommended to manage schizophrenia and prevent relapse, guidelines are unclear as to whether and when doctors should switch medications, reduce the dose, or discontinue medication. To gain clarity, the researchers analyzed published randomized clinical trials that included adults aged 18 years and older diagnosed with a schizophrenia-spectrum disorder and clinically stabilized on antipsychotic maintenance treatment.
They looked for studies that compared continuing the current antipsychotic at standard dose, reducing the current dose, switching to a different antipsychotic, and/or stopping the antipsychotic and replacing it with a placebo. A total of 98 studies were included in the analysis.
Researchers found all treatment strategies were more effective than stopping. Continuing the current treatment was the most effective, following by switching and reducing dosage.
“Switching to another antipsychotic was similarly effective compared to continuing at standard doses, whereas reducing the antipsychotic dose was significantly inferior compared to both continuing and switching,” researchers reported. “For every 3 individuals continuing antipsychotic treatment at standard doses, 1 additional individual will avoid relapse compared to stopping antipsychotic treatment, which can be regarded as a large effect magnitude.”
Moderate heterogeneity was observed across studies. Also studies defined relapse differently. And in studies where patients stopped medication, they stopped abruptly, which is not typical in the real world.
Despite the limitations, the researchers state that their secondary analysis confirmed the results. “Our findings support updating clinical guidelines to recognize that switching to another antipsychotic during maintenance treatment can be as effective as continuing antipsychotics at standard dose, whereas dose reduction below standard doses should be limited to selected cases,” they concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ostuzzi G, Vita G, Bertolini F, et al. Continuing, reducing, switching, or stopping antipsychotics in individuals with schizophrenia-spectrum disorders who are clinically stable: a systematic review and network meta-analysis. Lancet Psychiatry. 2022;9(8):614-624. doi:10.1016/S2215-0366(22)00158-4