title: Comparably high retention and low relapse rates in different subpopulations of bipolar patients in a German non-interventional study.
abstract: BACKGROUND
  Although a range of pharmacotherapeutical options are available for the treatment of bipolar disorder, patient non-adherence to prescribed treatment regimens and early treatment discontinuation remain among the primary obstacles to effective treatment. Therefore, this observational study assessed time on mood stabilizing medication and retention rates in patients with bipolar disorder (BD).
  
  
  METHODS
  In an 18-month, prospective, multicenter, non-interventional study conducted in Germany 761 outpatients (≥18 years) with BD and on maintenance therapy were documented. For analysis, patients were stratified by baseline medication: monotherapy olanzapine (OM, N = 186), lithium (LM, N = 152), anticonvulsants (N = 216), other mood stabilizing medication (OMS, N = 44); combination therapy olanzapine/lithium (N = 47), olanzapine/anticonvulsant (N = 68), other combinations (OC, N = 48). Continuation on medication was assessed as retention rates with 95% confidence intervals. Time to discontinuation and relapse-free time were calculated by Kaplan-Meier analysis. A relapse was defined as increase to CGI-BP >3, worsening of CGI-BP by ≥2 points, hospitalization or death related to BD. A Cox regression was calculated for the discontinuation of mood stabilizing therapy (reference: OM). Logistic regression models with stepwise forward selection were used to explore possible predictors of maintenance of treatment and relapse.
  
  
  RESULTS
  After 540 days (18 months), the overall retention rate of baseline medication was 87.7%, without notable differences between the cohorts. The overall mean time on mood stabilizing treatment was 444.7 days, with a range of 377.5 (OMS) to 481 (LM) by cohort. 74.0% of all patients were without relapse, with rates between the cohorts ranging from 58.4% (OC) to 80.2% (LM).
  
  
  CONCLUSIONS
  Retention rates exceeded controlled trial results in all treatment cohorts, in addition to other explanations possibly reflecting that the physicians were expertly adapting treatment regimens to the individual patient's disease characteristics and special needs.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kraemer
authors.forename: Anette
authors.initials: A
authors.lastname: Minarzyk
authors.forename: Steffen
authors.initials: S
authors.lastname: Eppendorfer
authors.forename: Carsten
authors.initials: C
authors.lastname: Henneges
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hundemer
authors.forename: Stefan
authors.initials: S
authors.lastname: Wilhelm
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D000077152:Olanzapine; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D008094:Lithium; D000077152:Olanzapine