The Influence of Previous Antipsychotic Polypharmacy Versus Monotherapy on the Effectiveness of Antipsychotic after Switching to Paliperidone Extended-release.
OBJECTIVE
Although antipsychotic polypharmacy is widely used in the pharmacotherapy of schizophrenia, its effectiveness is controversial. In particular, clinicians tend to avoid switching to monotherapy in patients who have been prescribed polypharmacy. In the present study, the authors investigate whether there is difference in time to discontinuation of antipsychotics between patients on previous monotherapy or polypharmacy.


METHODS
Pooled analysis was conducted on two 24-week, multicenter, open-label, non-comparative studies that were originally designed to investigate the effectiveness of switching to paliperidone extended-release (ER) in patients with schizophrenia. Patients were divided into two groups according to previously prescribed antipsychotics, that is, to a polypharmacy group or a monotherapy group. The primary outcome measure was time to discontinuation of paliperidone ER. In addition, the authors sought to identify clinical variables that influence time to discontinuation.


RESULTS
Before switching to paliperidone ER, 535 of 673 (79.5%) patients were prescribed antipsychotic monotherapy, and the remaining 138 (20.5%) patients were prescribed antipsychotic polypharmacy. No significant differences in time to discontinuation of paliperidone ER were observed between the polypharmacy and monotherapy groups. Personal and social performance scale score was the only factor found to influence time to discontinuation of paliperidone ER. No differences in psychopathology or adverse effects were found between the monotherapy and polypharmacy groups.


CONCLUSIONS
Our results suggest that number of antipsychotics prescribed before switching to monotherapy does not influence clinical prognosis in patients with schizophrenia.
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Hee-Won
HW
Lee
Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Kyoung-Sae
KS
Na
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Seung-Ho
SH
Jung
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Min-Hee
MH
Kang
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Jeong Seop
JS
Lee
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Jae-Nam
JN
Bae
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Hee-Yun
HY
Kim
Department of Psychiatry, Inha University Hospital, Incheon, Korea.
Chul-Eung
CE
Kim
9-Hydroxyrisperidone; Antipsychotic agents; Polypharmacy; Schizophrenia; Treatment outcome