Abstract
Rationale
The long-term effectiveness of olanzapine and aripiprazole in real clinical conditions at flexible doses in patients after hospital discharge has not been evaluated yet.
Objectives
This study was a multicenter retrospective cohort study. Patients with schizophrenia (n = 398) were prescribed olanzapine (n = 303) or aripiprazole (n = 95) at hospital discharge. The continuation of olanzapine or aripiprazole at 26, 52, or 104 weeks after the hospital discharge were compared using a Cox proportional hazards model and adjusted for possible confounders.
Results
The Kaplan–Meier survival curves revealed that the continuation of olanzapine at 26 (P = 0.001) and 52 weeks (P = 0.018) was significantly higher than that of aripiprazole but not at 104 weeks. Olanzapine was better than aripiprazole in efficacy at 26 (hazard ratio: 0.321, 95% confidence interval: 0.159–0.645, P = 0.001), 52 (hazard ratio: 0.405, 95% confidence interval: 0.209–0.786, P = 0.008), and 104 weeks (hazard ratio: 0.438, 95% confidence interval: 0.246–0.780, P = 0.005). Aripiprazole was better than olanzapine in tolerability at 104 weeks (hazard ratio: 4.574, 95% confidence interval: 1.415–14.787, P = 0.011). Rates after two years continuation of olanzapine and aripiprazole were not significantly different in patients with less than five years' duration of illness, but olanzapine was more commonly maintained for more than two years in those patients who had been ill for over five years' due to its greater efficacy.
Conclusion
Olanzapine treatment showed better continuation rates at 26 and 52 after hospital discharge than aripiprazole, whereas maintenance with the two antipsychotics did not differ significantly at 104 weeks, due reduced tolerability of long-term olanzapine treatment.
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Data Availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The authors would like to thank the Zikei Institute of Psychiatry (Okayama, Japan).
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The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
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T. Hosokawa, Y. Yoshimura, K. Washida, Y. Yada, S. Sakamoto, Y. Okahisa, S. Takao, A. Nomura, Y. Kishi, T. Harada, M. Takaki, T. Takeda, and N. Yamada participated in the design of the study, supervised the project, and contributed intellectually to the interpretation of the data. T. Hosokawa, Y. Yoshimura, K. Washida, Y. Yada, A. Nomura, Y. Kishi, and T. Harada investigated patient clinical records. C. Miyaji and S. Takao performed the statistical analyses. All authors contributed to and have approved the final manuscript.
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N.Y. has received unrestricted research funding from Daiichi Sankyo, Eisai, Pfizer, Otsuka, Astellas, and Merck Sharp & Dohme, which was deposited into research accounts at Okayama University. N.Y. has received honoraria for his participation as a speaker at educational events from UCB Japan, Tsumura, Pfizer, Dainippon-Sumitomo, Daiichi-Sankyo, Merck Sharp & Dohme, Pfizer, Eisai, Meiji-Seika, and Mochida.
M.T. has received honoraria for his participation as a speaker at education events sponsored by Daiichi Sankyo, Takeda, Tsumura, Otsuka, and Dainippon Sumitomo.
Y. Yada has received honoraria for speaking at educational events sponsored by Novartis, Otsuka, and Dainippon Sumitomo.
S.S. has received unrestricted research funding from Eli Lilly, which was deposited into research accounts at Okayama University Hospital. S.S. has received honoraria for his participation as a speaker at an educational event sponsored by Otsuka and Meiji-Seika.
Y.K. has received honoraria for his participation as a speaker at educational events sponsored by Novartis and Dainippon Sumitomo.
T. Hosokawa, C.M., Y. Yoshimura, Y.O., K. Washida, S.T., A.N., T. Harada, and T.T. report no additional financial or other relationship relevant to this article.
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Hosokawa, T., Miyaji, C., Yoshimura, Y. et al. Comparison between olanzapine and aripiprazole treatment for 104 weeks after hospital discharge in schizophrenia spectrum disorders: a multicenter retrospective cohort study in a real-world setting. Psychopharmacology 240, 1911–1920 (2023). https://doi.org/10.1007/s00213-023-06407-6
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DOI: https://doi.org/10.1007/s00213-023-06407-6