24 Feb Not All Polypharmacy for Schizophrenia is Bad
MedicalResearch.com Interview with:
Jari Tiihonen, MD, PhD
Professor, Department of Clinical Neuroscience
MedicalResearch.com: What is the background for this study?
Response: The effectiveness of antipsychotic combination therapy in schizophrenia relapse prevention is controversial, and use of multiple agents is generally believed to impair physical well-being. But the evidence for this are weak and antipsychotic polypharmacy is widely used.
MedicalResearch.com: What are the main findings?
Response: The results show that antipsychotic polypharmacy in general was associated with slightly lower risk of psychiatric rehospitalization than monotherapy. They do however not indicate that all types of polypharmacy are beneficial. Combining aripiprazole with clozapine was associated with the best outcome, having 14-23 percent lower risk of rehospitalization than clozapine alone; which was the the monotherapy associated with the best outcomes.
MedicalResearch.com: What should readers take away from your report?
Response: Our results indicate that the current treatment guidelines should tone down their categorical recommendations discouraging all antipsychotic polypharmacy. The evidence of superiority of polypharmacy might be sparse, and should be replicated in other countries, but there is no evidence at all on superiority of monotherapy over polypharmacy in the maintenance treatment of schizophrenia.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The results should be replicated in other countries
MedicalResearch.com: Is there anything else you would like to add?
Response: The study was funded by the Finnish Ministry of Social Affairs and the Academy of Finland.
No company has financed this study, but several of the authors have previously received funding/fees from pharmaceutical companies in different contexts. Two of the authors are employed by the contract research organisation EPID Research. The scientific article provides more detailed information about potential conflicts of interest
Tiihonen J, Taipale H, Mehtälä J, Vattulainen P, Correll CU, Tanskanen A. Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. JAMA Psychiatry. Published online February 20, 2019. doi:10.1001/jamapsychiatry.2018.4320
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