Effectiveness of Antipsychotic Use for Reducing Risk of Work Disability: Results From a Within-Subject Analysis of a Swedish National Cohort of 21,551 Patients With First-Episode Nonaffective Psychosis
Publication: American Journal of Psychiatry
Abstract
Objective:
The authors sought to determine whether antipsychotic use, compared with nonuse, is associated with lower work disability in first-episode nonaffective psychosis, and if so, for how long.
Methods:
A within-subject design was used to study the risk of sickness absence or disability pension during antipsychotic use compared with nonuse during a maximum of 11 years of follow-up (2006–2016) in a Swedish nationwide cohort of patients with first-episode nonaffective psychosis (N=21,551; age range, 16–45 years). The within-subject analyses were conducted with stratified Cox regression models, adjusted for time-varying factors, using each individual as her or his own control to eliminate selection bias. The primary outcome was work disability (sickness absence or disability pension).
Results:
Overall, 45.9% of first-episode patients had work disability during the median length of follow-up of 4.8 years. The risk of work disability was lower during use compared with nonuse of any antipsychotic (adjusted hazard ratio [aHR]=0.65, 95% CI=0.59–0.72). The lowest adjusted hazard ratios emerged for long-acting injectable antipsychotics (aHR=0.46, 95% CI=0.34–0.62), oral aripiprazole (aHR=0.68, 95% CI=0.56–0.82), and oral olanzapine (aHR=0.68, 95% CI=0.59–0.78). Long-acting injectables were associated with lower risk than olanzapine, the most commonly used oral antipsychotic (aHR=0.68, 95% CI=0.50–0.94). Adjusted hazard ratios were similar during the periods of <2 years, 2–5 years, and >5 years since diagnosis.
Conclusions:
Among individuals with first-episode nonaffective psychosis, antipsychotic treatment (with long-acting injectables in particular) was associated with about 30%–50% lower risk of work disability compared with nonuse of antipsychotics in the same individuals, which held true beyond 5 years after first diagnosis. These findings are informative regarding the important topic of early discontinuation of antipsychotic treatment after a first episode of nonaffective psychosis, but they need replication.
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History
Received: 3 December 2021
Revision received: 12 April 2022
Revision received: 5 June 2022
Accepted: 27 June 2022
Published online: 6 October 2022
Published in print: December 01, 2022
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Author Contributions
Drs. Solmi and Taipale contributed equally to this work.
Competing Interests
Dr. Solmi has received honoraria or served as a consultant for Angelini and Lundbeck. Dr. Taipale, Dr. Tanskanen, Dr. Mittendorfer-Rutz, and Prof. Tiihonen have participated in research projects funded by grants from Janssen-Cilag and Eli Lilly to their employing institution. Dr. Taipale has received personal fees from Janssen-Cilag and Otsuka. Dr. Correll has served as a consultant and/or adviser for or has received honoraria from AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Axsome, Boehringer Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Damitsa, Gedeon Richter, Hikma, Holmusk, Intra-Cellular Therapies, Janssen/Johnson & Johnson, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Seqirus, Servier, SK Life Science, Sumitomo Dainippon, Sunovion, Sun Pharma, Supernus, Takeda, Teva, and Viatris; he has provided expert testimony for Janssen and Otsuka; he has served on data safety monitoring boards for Lundbeck, Relmada, Reviva, Rovi, Supernus, and Teva; he has received grant support from Janssen and Takeda; he has received royalties from UpToDate; and he holds stock options in Cardio Diagnostics, LB Pharma, and Mindpax. Prof. Tiihonen has served as a consultant or adviser for and/or received honoraria from Eli Lilly, Evidera, Janssen-Cilag, Lundbeck, Mediuutiset, Orion, Otsuka, Sidera, Sunovion, and WebMD Global, and he has served as an advisory board member for Lundbeck.
Funding Information
Dr. Holm was supported by grant 310295 and Dr. Taipale by grants 315969 and 320107 from the Academy of Finland.
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