Effectiveness of maintenance treatments with atypical and typical antipsychotics in stable schizophrenia with early stage: 1-year naturalistic study.

摘要

RATIONALE: The relative effectiveness of the atypical antipsychotic drugs and conventional agents in patients with early-stage schizophrenia has not been comprehensively determined. OBJECTIVES: The aim of our study was to evaluate the efficacy and safety of seven antipsychotic drugs for the maintenance treatment in patients with early-stage schizophrenia. METHODS: In a 12-month open-label, prospective observational, multicenter study, 1,133 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine, or aripiprazole. The primary measure was the rate of treatment discontinuation for any reason. Secondary outcomes included measures for clinical and functional outcomes and tolerability. RESULTS: The percentage of patients discontinued treatment within 12 months was 41.4% for chlorpromazine, 39.5% for sulpiride, 36.7% for clozapine, 40.2% for risperidone, 39.6% for olanzapine, 46.9% for quetiapine, and 40.2% for aripiprazole, a nonsignificant difference (p = 0.717); there were no significant differences among these seven treatments on discontinuation due to relapse, intolerability, patient decision, or nonadherence (all p values >/= 0.260). Extrapyramidal symptoms were more prominent in chlorpromazine and sulpiride treatment groups. Anticholinergic side effects were most common with clozapine and chlorpromazine. Weight gain was most common with olanzapine and clozapine. CONCLUSIONS: The efficacy of seven antipsychotic medications for the maintenance treatment appeared similar in early-stage schizophrenia. With regard to the high dropout rate and side effects, special programs are needed to keep efficacy and safety of antipsychotics maintenance treatment for schizophrenia with early stage.