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Long-term outcomes of antipsychotic treatment in patients with first-episode schizophrenia: a systematic review

Authors Karson C, Duffy RA, Eramo A, Nylander A, Offord S

Received 15 September 2015

Accepted for publication 23 November 2015

Published 6 January 2016 Volume 2016:12 Pages 57—67


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Roger Pinder

Craig Karson,1 Ruth A Duffy,2 Anna Eramo,3 Anna-Greta Nylander,4 Steve J Offord5

1CNK Consultants, Delray Beach, FL, 2Medical Affairs – Neuroscience, Otsuka America Pharmaceutical, Inc., Princeton, NJ, 3Medical Affairs & Phase IV Clinical Affairs, Lundbeck LLC, Deerfield, IL, USA; 4Medical Affairs Aripiprazole, H Lundbeck A/S, Valby, Denmark; 5Medical Affairs, Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA

Background: Treatment during first-episode psychosis (FEP) or early schizophrenia may affect the rates of relapse and remission, as well as cognitive functioning, over time. Prolonged duration of psychosis is associated with a poor prognosis, but the effects of treatment in patients with FEP or early schizophrenia on the long-term outcomes are not well defined.
Objective: To understand the long-term effects of treatment with antipsychotic agents on remission, relapse, and cognition in patients with FEP or early schizophrenia.
Methods: Using PubMed and Scopus databases, a systematic review was undertaken of articles published between January 1, 2000, and May 20, 2015, that reported randomized and nonrandomized prospective clinical trials on the long-term effects of oral or long-acting injectable antipsychotics on measures of relapse, remission, or cognition in patients with FEP or early schizophrenia. For comparative purposes, trials reporting the effects of later intervention with antipsychotics in patients with longer disease history were also evaluated. Titles, abstracts, and full-text articles were independently screened for eligibility by all the authors based on the predefined criteria.
Results: Nineteen studies met inclusion criteria: 13 reported long-term outcomes of relapse, remission, or cognition following antipsychotic treatment in patients with FEP and six reported on patients with a longer disease history. Antipsychotic treatment in patients with FEP produced high rates of remission in the year following treatment initiation, and untreated FEP reduced the odds of later achieving remission. Maintenance therapy was more effective than treatment discontinuation or intermittent/guided discontinuation in preventing relapse. Initiating antipsychotic treatment in patients with FEP also produced sustained cognitive improvement for up to 2 years. Antipsychotic therapy also reduced the risk or rate of relapse in patients with a longer disease history, with outcomes in one study favoring a long-acting injectable formulation over an oral antipsychotic.
Conclusion: Treatment of patients with FEP is associated with benefits in the long-term outcomes of remission, relapse, and cognition. More long-term studies of treatment in patients with FEP are needed to confirm these findings.

Keywords: cognition, first-episode psychosis, long-term outcome, relapse, remission, schizophrenia

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