Evidence map›Paper›PMID 21536693›Full record

Trial reportThe American journal of psychiatry2011

Effectiveness of switching from antipsychotic polypharmacy to monotherapy.

Susan M Essock, Nina R Schooler, T Scott Stroup, Joseph P McEvoy, Ingrid Rojas, Carlos Jackson, Nancy H Covell, Schizophrenia Trials Network

Registry-linked trialAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The American journal of psychiatry, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00044655 (Effectiveness of Switching Antipsychotic Medications), which is not on this map. Cited by 50 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 6 pooled it
15.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00044655 phase4completednot on this map

Effectiveness of Switching Antipsychotic Medications

TypeinterventionalSponsorIcahn School of Medicine at Mount SinaiRan2001 to 2009Enrolled219ConditionsSchizophreniaArmsRisperidone, Olanzapine, Ziprasidone, Quetiapine, Aripiprazole
3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 6 syntheses or guidelines pooled it, 178 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Antipsychotic combinations for schizophrenia.The Cochrane database of systematic reviews · 2017
    Pooled it
  6. Pooled it
  7. Trial
  8. Trial
  9. Trial
  10. Validation of a claims-based antipsychotic polypharmacy measure.Pharmacoepidemiology and drug safety · 2014
    Trial
  11. Trial
  12. Trial
  13. Article
  14. Article
  15. Review
  16. Review
  17. Article
  18. Article
  19. Article
  20. Exploring Hidden Issues in the Use of Antipsychotic Polypharmacy in the Treatment of Schizophrenia.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2021
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Susan M EssockNew York State Psychiatric Institute, New York, NY 10032, USA. se2176@columbia.edu
Nina R Schooler
T Scott Stroup
Joseph P McEvoy
Ingrid Rojas
Carlos Jackson
Nancy H Covell
Schizophrenia Trials Network
Georgetown University · US

Funding

PUBLIC EDUCATION CAMPAIGN ON DEPRESSION DARTN01MH090001 · NIMH · UNIVERSITY OF NORTH CAROLINA CHAPEL HILL · 1989 to 2003
$10.4M
EFFECTIVENESS OF SWITCHING: CONVENTIONALS TO ATYPICALSR01MH059312 · NIMH · MOUNT SINAI SCHOOL OF MEDICINE OF NYU · PI ESSOCK, SUSAN M · 2001 to 2003
$4.5M
Pop-Track NIMHZ01MH900001 · NIMH · NATIONAL INSTITUTE OF MENTAL HEALTH · PI POP-TRACK, IC · 2002 to 2003
–
NIMH NIH HHS MH59312NIMH NIH HHS MH900001NIMH NIH HHS N01 MH090001NIMH NIH HHS R01 MH059312
6 · The paper itself

Abstract

objectiveThis randomized trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy.

methodAdult outpatients with schizophrenia taking two antipsychotics (127 participants across 19 sites) were randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. The trial lasted 6 months, with a 6-month naturalistic follow-up. Kaplan-Meier and Cox regression analyses examined time to discontinuation of assigned antipsychotic treatment, and random regression models examined additional outcomes over time.

resultsPatients assigned to switch to monotherapy had shorter times to all-cause treatment discontinuation than those assigned to stay on polypharmacy. By month 6, 86% (N=48) of those assigned to stay on polypharmacy were still taking both medications, whereas 69% (N=40) of those assigned to switch to monotherapy were still taking the same medication. Most monotherapy discontinuations entailed returning to the original polypharmacy. The two groups did not differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group lost weight, whereas the polypharmacy group gained weight.

conclusionsDiscontinuing one of two antipsychotics was followed by treatment discontinuation more often and more quickly than when both antipsychotics were continued. However, two-thirds of participants successfully switched, the groups did not differ with respect to symptom control, and switching to monotherapy resulted in weight loss. These results support the reasonableness of prescribing guidelines encouraging trials of antipsychotic monotherapy for individuals receiving antipsychotic polypharmacy, with the caveat that patients should be free to return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.

Indexed as

PolypharmacyAdolescentAdultAntipsychotic AgentsDiagnostic and Statistical Manual of Mental DisordersDrug Administration ScheduleDrug Therapy, CombinationFemaleHumansLongitudinal StudiesMaleProportional Hazards ModelsPsychiatric Status Rating ScalesPsychotic DisordersSchizophreniaTreatment OutcomeAntipsychotic Agents

Identifiers

PMID21536693
PMCPMC3739691
OpenAlexW2124291967

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.