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Citation
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Haro JM, Novick D, Suárez D, Alonso J, Lépine JP, Ratcliffe M, Kristensen KH, Gasquet I, Naber D, Mavreas VG, Murray D, Pancheri P, Slooff CJ, Teixeira JM, Bousoño M, Croudace T, Jones PB, Knapp M. J. Clin. Psychopharmacol. 2006; 26(6): 571-578. |
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Abstract
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Remission and relapse are clinical outcomes of increasing interest in schizophrenia. We analyzed remission and relapse, and the sociodemographic and clinical factors associated with these outcomes, in the usual care of schizophrenia using the 3-year, follow-up data from a large cohort of outpatients with schizophrenia taking part in the prospective, observational, European Schizophrenia Outpatient Health Outcomes study. Of the 6516 patients analyzed for remission, 4206 (64.6%) achieved remission during the 3-year, follow-up period. Logistic regression analysis revealed that being female, having a good level of social functioning at study entry, and a shorter duration of illness were factors significantly associated with achieving remission. Treatment with olanzapine was also associated with a higher frequency of remission compared with other antipsychotic agents. A Kaplan-Meier survival curve estimated that relapse occurred in approximately 25% of the patients who achieved remission, with the risk of relapse remaining constant during the follow-up period. Shorter duration of illness, having hostile behaviors, and substance abuse were factors associated with a higher risk of relapse, whereas good level of social functioning and the use of olanzapine and clozapine were associated with a lower risk of relapse. In conclusion, the 3-year results of the Schizophrenia Outpatient Health Outcomes study indicate that the likelihood of remission decreases over the longitudinal course of schizophrenia, but risk of relapse is maintained even after 3 years of achieving remission severity levels.
RESULTS suggest that treatment with olanzapine is associated with a better chance of achieving remission than other antipsychotics. Moreover, the use of olanzapine and clozapine is associated with a lower risk of relapse compared with risperidone, quetiapine, and typical antipsychotics. The results should be interpreted conservatively because of the observational, nonrandomized study design. © 2006 Lippincott Williams & Wilkins, Inc.; Indications:215 patients with schizophrenia.; Patients:6516 outpatients. 3753 males and 2763 females, mean age 40.2 years, 4206 remitters (2322 males and 1884 females, mean age 28.7 years) and 2310 nonremitters (1435 males and 875 females, mean age 28.0 years). Leponex group: n=215. Olanzapine group: n=3335. Risperidone group: n=1244. Quetiapine group: n=472. Amisulpride group: n=185. Follow-up was 3 years.; TypeofStudy:An open, international multicenter, observational, 3-year follow-up clinical study determining the frequency and relapse, and the sociodemographic and clinical factors (including treatment with Leponex, olanzapine, risperidone, quetiapine and amisulpride) associated with these outcomes, in outpatients with schizophrenia. The Schizophrenia Outpatient Health Outcomes (SOHO) study.; DosageDuration:A mean of 154.1-256.5 mg daily. Duration was 36 months.; ComparativeDrug:Olanzapine was given at a mean dose of 10.8 mg daily, risperidone 4.3-4.8 mg daily, and amisulpride 347.3-439.2 mg daily. Duration was 36 months.; Results:Of the 6516 patients, 4206 (64.6%) achieved remission during the 3-year follow-up and 2310 (35.4%) did not achieve remission. During the first year follow-up, 38.24% (2491/6516) of patients achieved remission. Compared with patients who did not achieve remission during the 3-year follow-up (nonremitters), patients who achieved remission during follow-up (remitters) were more frequently women, had a later age of onset of schizophrenia, a lower duration of illness, were less severely ill, and had a good level of social functioning at baseline (ie, more frequently working for pay, having a spouse or partner, and living independently). Almost twice as many remitters as nonremitters had never been treated before study entry (11.7% [492/4206] vs. 5.8% [134/6516], respectively). Mean doses at baseline and at 36 months revealed dose increases for all medications; small for olanzapine (10.8-12.2) and risperidone (1.3-4.8) and larger for quetiapine (247.2-439.5) and Leponex (154.1-256.2). Social functioning at study entry was one of the most important predictors of achieving symptomatic remission. Patients never treated for schizophrenia before study entry were also significantly more likely to achieve remission (P < 0.0001). In contrast, a longer duration of illness and being male were associated with a worse prognosis. Higher clinical severity, both in terms of overall severity and positive, negative, and cognitive symptoms, was associated with a significantly lower likelihood of achieving remission. Taking olanzapine was associated with a higher frequency of remission compared to all other antipsychotics. Receiving treatment with mood stabilizers or anxiolytics/hypnotics at baseline was associated with a worse prognosis. Approximately 25% of patients relapsed during the 3-year follow-up period, and the rate of relapse was constant throughout the whole period. Factors associated with a lower risk of relapse were a longer duration of illness and having paid employment at baseline. Using mood stabilizers, having attempted suicide, having hostile behaviors, and abusing substances were all associated with a higher risk of relapse. The use of Leponex and olanzapine was associated with a lower risk of relapse.; AdverseEffects:No adverse events were mentioned.; AuthorsConclusions:In conclusion, these 3-year results of the SOHO study indicate that remission in schizophrenia can occur at any time but tends to decrease in probability over the longitudinal course of the disease. We also found that the risk of relapse persists over time, supporting the need for long-term maintenance antipsychotic treatment. In this cohort study, typical antipsychotics, risperidone, and quetiapine, were associated with less favorable outcomes than olanzapine. There were no relevant differences between olanzapine and clozapine. The results should be interpreted conservatively because of the observational, nonrandomized study design.; FreeText:Clinical severity was assessed using the Clinical Global Impression (CGI) scale. This was subsequently expanded and validated as the CGI-Schizophrenia scale (CGI-SCH). The CGI and CGI-SCH values ranged from 1 (not ill) to 7 (among the most severely ill patients). Remission was defined as a score of 3 (mild severity) or less on a scale of 1 to 7 on the CGI overall severity score, the CGI positive symptoms score, the CGI negative symptoms score, and the CGI cognitive symptoms score, and maintained for a period of 6 months or more. Relapse was defined only for patients whose level of symptom severity reached remission (patients with a level of severity of mild or less on the CGI overall severity score [ie, ≤3) could present a relapse. Relapse was defined as an increase of at least 2 points on the CGI overall severity score from the minimum score achieved by the patient during the follow-up assessments, resulting in a rating of moderately ill or worse (score, ≥4), or having had a hospitalization. 9.6% (626/6516) of patients had never been treated with antipsychotics before inclusion in the study, and most patients had a long duration of illness (time since first treatment was 11.8 years). Approximately 1 in 5 patients had paid employment at study entry, and 29% (1629/6516) had a spouse or partner at baseline. An unspecified number of patients received mood stabilizers or anxiolytics/hypnotics, and antidepressants concomitantly.
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