title: Comparative effectiveness of second-generation antipsychotic medications in early-onset schizophrenia.
abstract: Scant information exists to guide pharmacological treatment of early-onset schizophrenia. We examine variation across commonly prescribed second-generation antipsychotic medications in medication discontinuation and psychiatric hospital admission among children and adolescents clinically diagnosed with schizophrenia. A 45-state Medicaid claims file (2001-2005) was analyzed focusing on outpatients, aged 6-17 years, diagnosed with schizophrenia or a related disorder prior to starting a new episode of antipsychotic monotherapy with risperidone (n = 805), olanzapine (n = 382), quetiapine (n = 260), aripiprazole (n = 173), or ziprasidone (n = 125). Cox proportional hazard regressions estimated adjusted hazard ratios of 180-day antipsychotic medication discontinuation and 180-day psychiatric hospitalization for patients treated with each medication. During the first 180 days following antipsychotic initiation, most youth treated with quetiapine (70.7%), ziprasidone (73.3%), olanzapine (73.7%), risperidone (74.7%), and aripirazole (76.5%) discontinued their medication (χ(2) = 1.69, df = 4, P = .79). Compared with risperidone, the adjusted hazards of antipsychotic discontinuation did not significantly differ for any of the 4-comparator medications. The percentages of youth receiving inpatient psychiatric treatment while receiving their initial antipsychotic medication ranged from 7.19% (aripiprazole) to 9.89% (quetiapine) (χ(2) = 0.79, df = 4, P = .94). As compared with risperidone, the adjusted hazard ratio of psychiatric hospital admission was 0.96 (95% CI: 0.57-1.61) for olanzapine, 1.03 (95% CI: 0.59-1.81) for quetiapine, 0.85 (95% CI: 0.43-1.70) for aripiprazole, and 1.22 (95% CI: 0.60-2.51) for ziprasidone. The results suggest that rapid antipsychotic medication discontinuation and psychiatric hospital admission are common in the community treatment of early-onset schizophrenia. No significant differences were detected in risk of either adverse outcome across 5 commonly prescribed second-generation antipsychotic medications.
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA. mo49@columbia.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.forename: Cecilia
authors.initials: C
authors.lastname: Huang
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lieberman
authors.forename: William V
authors.initials: WV
authors.lastname: Bobo
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D002648:Child; D003987:Dibenzothiazepines / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D011618:Psychotic Disorders / Q000188:drug therapy*; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000627:therapeutic use; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy*; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine