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Effect of discontinuation v. maintenance of antipsychotic medication on relapse rates in patients with remitted/stable first-episode psychosis: a meta-analysis

Published online by Cambridge University Press:  18 June 2018

Taro Kishi ,
Toshikazu Ikuta ,
Yuki Matsui ,
Ken Inada ,
Yuki Matsuda ,
Kazuo Mishima  and
Nakao Iwata
Taro Kishi*
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
Toshikazu Ikuta
Affiliation:
Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University, MS 38677, USA
Yuki Matsui
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
Ken Inada
Affiliation:
Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Tokyo 162-8666, Japan
Yuki Matsuda
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan
Kazuo Mishima
Affiliation:
Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
Nakao Iwata
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
*
Author for correspondence: Taro Kishi, E-mail: tarok@fujita-hu.ac.jp
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Abstract

Background

Discontinuation of antipsychotics predisposes patients with remitted/stable first-episode psychosis (FEP) to a higher risk of relapse, but it remains unclear how long discontinuation increases the relapse rate in these patients compared with maintenance.

Methods

This meta-analysis of randomized controlled trials (RCTs) compared relapse rates in FEP patients between antipsychotic treatment discontinuation and maintenance groups at 1, 2, 3, 6, 9, 12 (primary), and 18–24 months. The risk ratio (RR) and numbers needed to treat/harm (NNT/NNH) were calculated using a random-effects model.

Results

Ten RCTs were identified (n = 776; mean study duration, 18.6 ± 6.0 months). The antipsychotics were discontinued abruptly in four RCTs (which reported data only at 12 months) and after tapering off gradually over several months (mean length, 3 months) in six RCTs. Compared with the discontinuation group, the maintenance group experienced significantly fewer relapses at all time points except 1 month [RR (NNT): 2 months, 0.49 (13); 3 months, 0.46 (9); 6 months, 0.55 (6); 9 months, 0.48 (3); 12 months, 0.47 (3); and 18–24 months, 0.57 (4)]. The maintenance group was associated with higher discontinuation due to adverse events (RR, 2.61; NNH, not significant).

Conclusions

Maintaining antipsychotic treatment prevented relapse for up to 24 months in FEP patients. Discontinuation of antipsychotics for ⩾2 months significantly increased the risk of relapse. However, 45.7% of patients who discontinued antipsychotics for 12 months (39.4% after 18–24 months) did not experience a relapse.

Keywords

Antipsychotics discontinuationantipsychotics maintenancefirst-episode psychosismeta-analysisrelapse ratesystematic review
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 5 , April 2019 , pp. 772 - 779
Copyright
Copyright © Cambridge University Press 2018 

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