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Published Online: 1 July 2011

Effectiveness of Switching From Antipsychotic Polypharmacy to Monotherapy

Susan M. Essock, Ph.D., Nina R. Schooler, Ph.D., T. Scott Stroup, M.D., M.P.H., Joseph P. McEvoy, M.D., Ingrid Rojas, Carlos Jackson, Ph.D., and Nancy H. Covell, Ph.D. The Schizophrenia Trials NetworkAuthors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 168, Number 7
https://doi.org/10.1176/appi.ajp.2011.10060908
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Abstract

Objective:

This randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy.

Method:

Adult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time.

Results:

Patients assigned to switch to monotherapy had shorter times to all-cause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight.

Conclusions:

Discontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 168 • Number 7 • July 2011
Pages: 702 - 708
PubMed: 21536693

History

Received: 28 June 2010
Revision received: 1 December 2010
Revision received: 12 January 2011
Accepted: 14 February 2011
Published online: 1 July 2011
Published in print: July 2011

Authors

Affiliations

Susan M. Essock, Ph.D.
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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Nina R. Schooler, Ph.D.
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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T. Scott Stroup, M.D., M.P.H.
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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Joseph P. McEvoy, M.D.
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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Ingrid Rojas
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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Carlos Jackson, Ph.D.
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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Nancy H. Covell, Ph.D.
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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The Schizophrenia Trials Network
From the New York State Psychiatric Institute; Department of Psychiatry, Columbia University; Department of Psychiatry, Georgetown University School of Medicine; VA VISN 5 Mental Illness Research, Education, and Clinical Center; and Department of Psychiatry, Duke University Medical Center.
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Notes

Address correspondence and reprint requests to Dr. Essock, New York State Psychiatric Institute, 1051 Riverside Dr., Box 100, New York, NY 10032; [email protected] (e-mail).

Funding Information

Dr. Schooler has received honoraria or research grants from or served as a consultant or adviser to Abbott, AstraZeneca, Bristol-Myers Squibb, Dainippon Sumitomo, Eli Lilly, Hoffman LaRoche, Johnson & Johnson, Lundbeck, Merck, Ortho-McNeil Janssen, Pfizer, and Schering-Plough. Dr. Stroup has worked as a consultant to Janssen and Eli Lilly. Dr. McEvoy has received honoraria or research grants from or served as a consultant or adviser to Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutica, Merck, Novartis, Organon, Pfizer, Roche, Solvay, Sunovion, and Targacept. The other authors report no financial relationships with commercial interests.Supported by NIMH grant MH59312 (to Dr. Essock) and by NIMH contract MH900001 (to Dr. Stroup).

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