title: Effectiveness of switching from antipsychotic polypharmacy to monotherapy.
abstract: OBJECTIVE
  This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy.
  
  
  METHODS
  Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time.
  
  
  RESULTS
  Patients assigned to switch to monotherapy had shorter times to all-cause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight.
  
  
  CONCLUSIONS
  Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.
authors.affiliation: New York State Psychiatric Institute, New York, NY 10032, USA. se2176@columbia.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
authors.forename: Nina R
authors.initials: NR
authors.lastname: Schooler
authors.forename: T Scott
authors.initials: TS
authors.lastname: Stroup
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McEvoy
authors.forename: Ingrid
authors.initials: I
authors.lastname: Rojas
authors.forename: Carlos
authors.initials: C
authors.lastname: Jackson
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Covell
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019338:Polypharmacy; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents