Relapse Rates in Patients With Schizophrenia Receiving Aripiprazole in Comparison With Other Atypical Antipsychotics
J Clin Psychiatry 2006;67:1942-1947
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Aripiprazole is the first of a new
generation of antipsychotics that possesses a
unique mechanism of action as a partial dopamine
agonist. After the release of aripiprazole, case reports
appeared conveying an acute psychosis/agitation reaction occurring after the initiation of
treatment, most specifically after patients were switched
from a previous antipsychotic to aripiprazole. The
primary objective of this study was to compare relapse rates among patients with schizophrenia
who were switched to aripiprazole with those who switched to a second-generation
antipsychotic (SGA) from another antipsychotic.
Method: The design was a retrospective
cohort study based on Kansas Medicaid enrollees with
an ICD-9-CM diagnosis code for schizophrenia
during calendar year 2002 who switched
antipsychotic agents. Six-month psychiatric relapse rates,
defined as hospitalization for a psychiatric event,
were compared between those subjects who switched
to aripiprazole and those who switched to another SGA. Time to relapse was modeled using Cox
proportional hazards, adjusting for demographic
characteristics, major comorbid conditions, and
prior psychiatric-related health care use.
Results: Four hundred forty-four
aripiprazole and 521 SGA switchers were comparable with
respect to gender, race, comorbidities, and health
care utilization, though the aripiprazole group was
4.5 years younger. Twenty percent of aripiprazole
patients and 19.4% of patients receiving SGAs were hospitalized 6 months after being switched
(relative risk = 0.92; 95% CI = 0.67 to 1.26). Mean times
to psychiatric hospitalization for the aripiprazole
and SGA groups were 65.7 and 73.8 days,
respectively (p > .05). Factors associated with
hospitalization were prior psychiatric hospitalizations and
comorbid depression, substance abuse, and neurotic,
personality, and nonpsychotic mental disorders.
Conclusion: Our study found that rates of
relapse and time to relapse with aripiprazole were comparable to other SGAs during a 6-month
period. Thus, aripiprazole appears to be an
appropriate first-line agent along with the other SGAs.