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Reduced Antipsychotic Doses During Schizophrenia Maintenance Increase Relapse Risk
Lowering an antipsychotic dose below the standard range recommended for acute stabilization appears to increase both relapse risk and all-cause discontinuation during maintenance treatment in patients with multi-episode schizophrenia, according to a systematic review and meta-analysis published in The Lancet Psychiatry.
The meta-analysis included 22 studies that reported on 24 randomized controlled trials spanning 3282 adults with schizophrenia or schizoaffective disorder. Researchers were interested in outcomes with reduced versus standard doses of antipsychotics during maintenance treatment.
Antipsychotics at a low dose, specifically within 50% to 99% of the lower limit of the standard dose, increased relapse risk by 44% and all-cause discontinuation risk by 12%, according to the meta-analysis. Antipsychotics at a very low dose, or less than 50% of the lower limit of the standard dose, increased relapse risk by 72% and all-cause discontinuation risk by 31%.
When researchers compared low-dose and very low-dose antipsychotics, differences in risk of relapse and all-cause discontinuation risk were not significant.
Subgroup comparisons of double-blind and open-label studies, first-generation and second-generation antipsychotics, and oral and long-acting injectable antipsychotics produced results consistent with the overall findings, researchers added.
“During maintenance treatment in multi-episode schizophrenia, antipsychotic doses should probably not be reduced below the standard dose range recommended for acute stabilization,” they advised, “because reducing the dose further is associated with an increased risk of both relapse and all-cause discontinuation.”
—Jolynn Tumolo
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