To continue or not continue that is the question
Background:
A previous Dutch study showed better functional recovery in a group that reduced dose and attempted to stop antipsychotic maintenance treatment after a first psychotic episode (FEP), as compared to the group who continued maintenance medication1. This finding was remarkable, as it contrast findings of Scandinavian Registry studies, who generally reported worse outcome in patients with early discontinuation. In September 2017, the HAMLETT study was started to investigate the effect of early discontinuation in a large sample of 512 FEP patients.
Method:
26 Dutch centers participate in an open-label RCT in which patients who have reached remission after a FEP are randomized 1:1 to either continuation of maintenance treatment for at least 1 year, or to dose reduction/ discontinuation after 3 months remission.
Results (preliminary):
So far 350 patients have been included. We noted that patients are generally eager to discontinue, even when provided information about the high risk for relapse.
Remarkably, from 26 participating centers, 18 are already using the policy to taper off medication soon after remission, which contrasts to Dutch and international guidelines. Knowledge about risks of relapse is variable among doctors. Discontinuation is generally performed gradually over the course of 3-6 months.
Conclusion:
Although most studies show worse outcome for discontinuation as compared to continuation of maintenance therapy, patients have a clear preference to discontinue.
Presenter: Marieke Begemann
Marieke Begemann studied Neuropsychology at Utrecht University, the Netherlands. She performed her PhD with Prof. Dr. Iris Sommer in the UMC Utrecht (Department of Psychiatry), studying the topic of childhood trauma as a risk factor for clinical and non-clinical psychotic symptoms. She combined her PhD activities with coordinating a multicenter randomized double-blind placebo-controlled trial on simvastatin augmentation in recent-onset psychosis and a teaching position at Utrecht University, Department of Experimental Psychology. In 2017, Marieke was appointed as a postdoctoral research fellow in the UMC Groningen (Department of Biomedical Sciences of Cells and Systems) in the lab of Iris Sommer. She is project manager of the large HAMLETT-OPHELIA cohort,investigating the longterm aspects of antipsychotic medication. Collaborating with 23 Dutch health care institutions, 512 first-episode patients will be included across the Netherlands. Marieke was awarded a Travel Fellowship by the Schizophrenia International Research Society in 2018.