MedicalResearch.com Interview with:
Jari Tiihonen, MD, PhD
Professor, Department of Clinical Neuroscience
MedicalResearch.com: What are the limitations of existing analyses of the comparative effectiveness of antipsychotics?
Response: It has remained unclear if there are clinically meaningful differences between antipsychotic treatments in relapse prevention of schizophrenia, due to the impossibility of including large unselected patient populations in randomized controlled trials, and due to residual confounding from selection biases in observational studies.
MedicalResearch.com: In very broad terms, what did you find?
Response: Clozapine and long-acting injectables (LAIs) are the most effective pharmacological treatments for relapse prevention in schizophrenia, and the risk of re-hospitalization is about 20–30% lower during LAI treatments compared with equivalent orals.
MedicalResearch.com: What are the strengths and limitations of your study?
Response: The strength of our study was that it included all patients in Sweden, and each individual was used as his/her own control to eliminate selection bias. Limitation was that although time-dependent factors such as aging are adjusted in the within-individual analysis, there always remains a possibility of residual confounding related to passing of calendar time. For example, we did not have data on co-treatment with psychological therapies or use of mood stabilizers. However, it is unlikely that there would be systematical differences between antipsychotics in this regard.
MedicalResearch.com: What are the next steps in this research?
Response: Next step would be to study first episode patients in a larger cohort, which would enable comparing effectiveness of specific treatments also among these new patients.
Disclosures: Jari Tiihonen has served as a consultant to the Finnish Medicines Agency Fimea, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, F. Hoffman-La Roche, Janssen-Cilag, Lundbeck, and Organon; he has received fees for giving expert testimonies to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Otsuka and Pfizer; lecture fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Novartis, Otsuka, Pfizer; and grants from Stanley Foundation and Sigrid Jusélius Foundation. Tiihonen is a member of the advisory boards for AstraZeneca, Eli Lilly, Janssen-Cilag, and Otsuka, and has participated in research projects funded by Janssen-Cilag and Eli Lilly with grants paid to Karolinska Institutet. Fabian Hoti, Maila Majak, and Juha Mehtälä are employed by EPID Research, which is a contract research organization that performs commissioned pharmacoepidemiological studies and thus its employees have been and currently are working in collaboration with several pharmaceutical companies. Antti Tanskanen and Heidi Taipale have participated in research projects funded by Janssen-Cilag and Eli Lilly with grants paid to the Karolinska Institutet, Tanskanen is a member of advisory board for Janssen-Cilag. Erik Jedenius, Dana Enkusson, Amy Leval, and Jan Sermon are employed by Janssen Cilag Pharmaceuticals. Ellenor Mittendorfer-Rutz reports no conflict of interest.
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Tiihonen J, Mittendorfer-Rutz E, Majak M, Mehtälä J, Hoti F, Jedenius E, Enkusson D, Leval A, Sermon J, Tanskanen A, Taipale H. Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia. JAMA Psychiatry. Published online June 07, 2017. doi:10.1001/jamapsychiatry.2017.1322
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