Continuing or Switching Antipsychotic Treatment Best Protects Against Relapse

In patients with clinically stable schizophrenia-spectrum disorders, continuing antipsychotic treatment at standard doses or switching to a different antipsychotic are similarly effective for preventing relapse, according to results from a network meta-analysis published in Lancet Psychiatry.

“Although antipsychotic maintenance treatment is widely recommended to prevent relapse in chronic psychoses, evidence-based guidelines do not provide clear indications on different maintenance treatment strategies, including continuing the antipsychotic at standard doses, reducing the dose, switching to another antipsychotic, or even stopping the antipsychotic,” wrote corresponding author Giovanni Ostuzzi, PhD, of the University of Verona in Italy and coauthors. “We aimed to compare the effectiveness of these maintenance treatment strategies.”

The systematic review identified 98 randomized controlled trials that investigated antipsychotic for relapse prevention for the meta-analysis. Approximately 90% were conducted in high-income or upper-middle-income countries, and White/Caucasian participants appeared to be the most represented ethnic group. Men averaged 62% of participants in each study.

Compared with stopping antipsychotic treatment altogether, all continuation strategies were significantly more effective for avoiding relapse, meta-analysis showed. Continuing antipsychotics at standard doses, as well as switching antipsychotics, provided large and similar reductions in relapse risk. Meanwhile, reducing antipsychotic doses offered moderate risk reduction. A moderate confidence of evidence supported the findings, which were confirmed in secondary analyses, sensitivity, and subgroup analyses.

Tolerability was similar for all strategies.

“Despite limitations, including moderate heterogeneity and moderate certainty of evidence, these results are of pragmatic relevance for clinicians,” researchers advised, “and should support the update of evidence-based guidelines.”

Reference

Ostuzzi G, Vita G, Bertolini F, et al. Continuing, reducing, switching, or stopping antipsychotics in individuals with schizophrenia-spectrum disorders who are clinically stable: a systematic review and network meta-analysis. Lancet Psychiatry. 2022 Aug;9(8):614-624. doi: 10.1016/S2215-0366(22)00158-4