{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:09:57Z","timestamp":1792444197531,"version":"4.5.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Antipsychotics are the cornerstone of maintenance treatment in schizophrenia spectrum disorders, but it is unclear which agents should be prioritized by prescribers.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the clinical effectiveness of antipsychotics, including recent market entries, in comparison with oral olanzapine in relapse and treatment failure prevention among individuals with schizophrenia spectrum disorder.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This comparative effectiveness research study with a within-individual analysis included data from Swedish health care registers of inpatient and specialized outpatient care, sickness absence, and disability pensions among all individuals aged 16 to 65 years who were diagnosed with schizophrenia spectrum disorder from January 1, 2006, to December 31, 2021, including an incident cohort and a prevalent cohort.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Specific antipsychotics.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The risks for psychosis relapse hospitalization and treatment failure (psychiatric hospitalization, death, or change in an antipsychotic medication) were adjusted for the temporal order of treatments, time since cohort entry, and concomitant drugs. Comparisons of all antipsychotics with oral olanzapine, the most commonly used antipsychotic, were investigated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among the full cohort of 131 476 individuals, the mean (SD) age of the study cohort was 45.7 (16.2) years (70 054 men [53.3%]). During a median follow-up of 12.0 years [IQR, 5.2-16.0 years], 48.5% of patients (N\u2009=\u200963\u202f730) experienced relapse and 71.1% (N\u2009=\u200993\u202f464) underwent treatment failure at least once. Compared with oral olanzapine, paliperidone 3-month long-acting injectable (LAI) was associated with the lowest adjusted hazard ratio (AHR) in the prevention of relapses (AHR, 0.66; 95% CI, 0.51-0.86), followed by aripiprazole LAI (AHR, 0.77 [95% CI, 0.70-0.84]), olanzapine LAI (AHR, 0.79 [95% CI, 0.73-0.86]), and clozapine (AHR, 0.82 [95% CI, 0.79-0.86]). Quetiapine was associated with the highest risk of relapse (AHR, 1.44 [95% CI, 1.38-1.51]). For prevention of treatment failure, paliperidone 3-month LAI was associated with the lowest AHR (AHR, 0.36 [95% CI, 0.31-0.42]), followed by aripiprazole LAI (AHR, 0.60 [95% CI, 0.57-0.63]), olanzapine LAI (AHR, 0.67 [95% CI, 0.63-0.72]), and paliperidone 1-month LAI (AHR, 0.71 [95% CI, 0.68-0.74]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This comparative effectiveness research study demonstrated large differences in the risk of relapse and treatment failure among specific antipsychotic treatments. The findings contradict the widely held conception that all antipsychotics are equally effective in relapse prevention.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.38358","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T11:15:55Z","timestamp":1728472555000},"page":"e2438358","source":"Crossref","is-referenced-by-count":35,"title":["Comparative Effectiveness of Antipsychotics in Patients With Schizophrenia Spectrum Disorder"],"prefix":"10.1001","volume":"7","author":[{"given":"Aleksi","family":"Hamina","sequence":"first","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"},{"name":"Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Taipale","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Lieslehto","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markku","family":"L\u00e4hteenvuo","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Tanskanen","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellenor","family":"Mittendorfer-Rutz","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari","family":"Tiihonen","sequence":"additional","affiliation":[{"name":"Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"issue":"1","key":"zoi241113r1","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1471-244X-13-50","article-title":"The nature of relapse in schizophrenia.","volume":"13","author":"Emsley","year":"2013","journal-title":"BMC Psychiatry"},{"issue":"8","key":"zoi241113r2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008016.pub3","article-title":"Maintenance treatment with antipsychotic drugs for schizophrenia.","volume":"8","author":"Ceraso","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"9","key":"zoi241113r3","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1007\/s40273-017-0515-3","article-title":"The cost of relapse in schizophrenia.","volume":"35","author":"Pennington","year":"2017","journal-title":"Pharmacoeconomics"},{"issue":"4","key":"zoi241113r4","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1192\/bjp.184.4.346","article-title":"Relapse in schizophrenia: costs, clinical outcomes and quality of life.","volume":"184","author":"Almond","year":"2004","journal-title":"Br J Psychiatry"},{"issue":"2","key":"zoi241113r5","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1002\/wps.20972","article-title":"Oral and long-acting antipsychotics for relapse prevention in schizophrenia-spectrum disorders: a network meta-analysis of 92 randomized trials including 22,645 participants.","volume":"21","author":"Ostuzzi","year":"2022","journal-title":"World Psychiatry"},{"issue":"10327","key":"zoi241113r6","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/S0140-6736(21)01997-8","article-title":"Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis.","volume":"399","author":"Schneider-Thoma","year":"2022","journal-title":"Lancet"},{"issue":"1","key":"zoi241113r7","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1038\/s41537-021-00192-x","article-title":"Systematic literature review of schizophrenia clinical practice guidelines on acute and maintenance management with antipsychotics.","volume":"8","author":"Correll","year":"2022","journal-title":"Schizophrenia (Heidelb)"},{"issue":"10","key":"zoi241113r8","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1176\/appi.ajp.2020.20111657","article-title":"Differences in antipsychotic treatment discontinuation among veterans with schizophrenia in the U.S. Department of Veterans Affairs.","volume":"178","author":"Weiser","year":"2021","journal-title":"Am J Psychiatry"},{"issue":"12","key":"zoi241113r9","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1056\/NEJMoa051688","article-title":"Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.","volume":"353","author":"Lieberman","year":"2005","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi241113r10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1001\/jamapsychiatry.2021.3990","article-title":"Representation and outcomes of individuals with schizophrenia seen in everyday practice who are ineligible for randomized clinical trials.","volume":"79","author":"Taipale","year":"2022","journal-title":"JAMA Psychiatry"},{"issue":"5","key":"zoi241113r11","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/S2215-0366(21)00039-0","article-title":"Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies.","volume":"8","author":"Kishimoto","year":"2021","journal-title":"Lancet Psychiatry"},{"issue":"7","key":"zoi241113r12","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1001\/jamapsychiatry.2017.1322","article-title":"Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29?823 patients with schizophrenia.","volume":"74","author":"Tiihonen","year":"2017","journal-title":"JAMA Psychiatry"},{"issue":"6","key":"zoi241113r13","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1093\/schbul\/sbx176","article-title":"Comparative effectiveness of antipsychotic drugs for rehospitalization in schizophrenia\u2014a nationwide study with 20-year follow-up.","volume":"44","author":"Taipale","year":"2018","journal-title":"Schizophr Bull"},{"key":"zoi241113r14","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12911-015-0140-z","article-title":"From prescription drug purchases to drug use periods\u2014a second generation method (PRE2DUP).","volume":"15","author":"Tanskanen","year":"2015","journal-title":"BMC Med Inform Decis Mak"},{"issue":"5","key":"zoi241113r16","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s40263-022-00917-1","article-title":"Impact of 3-monthly long-acting injectable paliperidone palmitate in schizophrenia: a retrospective, real-world analysis of population-based health records in Spain.","volume":"36","author":"Guti\u00e9rrez-Rojas","year":"2022","journal-title":"CNS Drugs"},{"issue":"3","key":"zoi241113r17","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1080\/03007995.2018.1560220","article-title":"Real-world outcomes post-transition to once-every-3-months paliperidone palmitate in patients with schizophrenia within US commercial plans.","volume":"35","author":"Emond","year":"2019","journal-title":"Curr Med Res Opin"},{"issue":"3","key":"zoi241113r18","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1093\/schbul\/sbx090","article-title":"Effectiveness of long-acting injectable vs oral antipsychotics in patients with schizophrenia: a meta-analysis of prospective and retrospective cohort studies.","volume":"44","author":"Kishimoto","year":"2018","journal-title":"Schizophr Bull"},{"issue":"5","key":"zoi241113r19","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1176\/appi.ajp.2020.20071120","article-title":"Maintenance treatment with long-acting injectable antipsychotics for people with nonaffective psychoses: a network meta-analysis.","volume":"178","author":"Ostuzzi","year":"2021","journal-title":"Am J Psychiatry"},{"issue":"6","key":"zoi241113r20","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1093\/schbul\/sbab063","article-title":"Long-term continuity of antipsychotic treatment for schizophrenia: a nationwide study.","volume":"47","author":"Rubio","year":"2021","journal-title":"Schizophr Bull"},{"issue":"3","key":"zoi241113r21","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1002\/wps.20060","article-title":"Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies.","volume":"12","author":"Kane","year":"2013","journal-title":"World Psychiatry"},{"issue":"4","key":"zoi241113r22","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1007\/s00406-023-01654-2","article-title":"A network meta-analysis of efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia.","volume":"274","author":"Dong","year":"2024","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"issue":"12","key":"zoi241113r25","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1001\/jamapsychiatry.2020.2076","article-title":"Effect of long-acting injectable antipsychotics vs usual care on time to first hospitalization in early-phase schizophrenia: a randomized clinical trial.","volume":"77","author":"Kane","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"8","key":"zoi241113r26","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1001\/jamapsychiatry.2015.0270","article-title":"Long-acting injectable risperidone for relapse prevention and control of breakthrough symptoms after a recent first episode of schizophrenia: a randomized clinical trial.","volume":"72","author":"Subotnik","year":"2015","journal-title":"JAMA Psychiatry"},{"issue":"1-3","key":"zoi241113r27","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.schres.2015.08.015","article-title":"Paliperidone palmitate versus oral antipsychotics in recently diagnosed schizophrenia.","volume":"169","author":"Schreiner","year":"2015","journal-title":"Schizophr Res"},{"key":"zoi241113r15","doi-asserted-by":"crossref","DOI":"10.4135\/9781412993869","volume-title":"Fixed Effects Regression Models (Quantitative Applications in the Social Sciences)","author":"Allison","year":"2009"},{"key":"zoi241113r23","volume-title":"The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia","author":"American Psychiatric Association","year":"2021","edition":"3rd ed"},{"key":"zoi241113r24","unstructured":"Psychosis and schizophrenia in adults: prevention and management. National Institute for Health and Care Excellence. Updated March 1, 2014. Accessed February 10, 2024. https:\/\/www.nice.org.uk\/Guidance\/CG178"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2824666\/hamina_2024_oi_241113_1727811696.63881.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T11:15:58Z","timestamp":1728472558000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2824666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,9]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.38358","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,9]]}}}