title: Gradual vs. wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis.
abstract: To address whether wait discontinuation (i.e., introducing the new antipsychotic while maintaining the first for a period before initiating its discontinuation) is superior to non-wait discontinuation (i.e., initiating the first antipsychotic's discontinuation when introducing the new antipsychotic) in antipsychotic switching, we conducted a meta-analysis of randomized controlled trials comparing gradual vs. wait-and-gradual antipsychotic discontinuation in patients with schizophrenia. The meta-analysis of 5 studies (n=410) demonstrated no significant differences in any clinical outcomes, including study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events, between the two groups. These findings indicate either strategy can be used in clinical practice.
authors.affiliation: Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. Electronic address: hirotak@dk9.so-net.ne.jp.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Takeuchi
authors.affiliation: Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Anthropology, University of Toronto, Toronto, Canada.
authors.forename: Sadhana
authors.initials: S
authors.lastname: Thiyanavadivel
authors.affiliation: Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
authors.forename: Ofer
authors.initials: O
authors.lastname: Agid
authors.affiliation: Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Remington
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D057915:Drug Substitution / Q000523:psychology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotics; Discontinuation; Schizophrenia; Switching strategy