Use and Discontinuation of Antipsychotic Medication Results from the OPUS Trial 20 years follow-up

Background and hypothesis: Exposure to antipsychotics has proven to be beneficial on the short-term. However, studies are lacking regarding the effectiveness of long-term use. The aim of this study was to investigate changes in use of antipsychotics through a period of 20-years after a first-episode schizophrenia.

Study design: This study is part of the Danish OPUS trial (1998-2000), including 496 participants with first-episode schizophrenia and followed through interviews over 20-years. Main outcomes were number of medicated days, redeemed prescriptions of clozapine, psychiatric hospitalizations, and employments.

Study results: At the 20-year follow-up 143 participated with 36% (n=51) in remission-of-psychotic-symptoms-off-medication. Also, the lowest number of medicated days (mean (SD), 339 (538) days) with 5% of observed days spent in treatment with antipsychotics was found in this group. Using the Danish registers with data on redeemed antipsychotics on all trial participants (n=416), those in treatment with antipsychotics (n=120) at the 20-year follow-up had spent significantly more days in treatment (5405 (1857) vs. 1434 (1819) mean days, P=.00) and more had ever redeemed a prescription of clozapine (25% vs. 7.8%, P=.00) than those who had discontinued antipsychotics (n=296). Further, the discontinue group had significantly higher employment the past year prior to the 20-year follow-up (28.4% vs. 12.5%, P=.00).

Conclusions: A substantial part were in remission-of-psychotic-symptoms-off-medication with high persistence over 20 years. Further, those in treatment with antipsychotics differed significantly with more days spent in treatment, higher ever redeemed prescriptions of clozapine and fewer in employment than those who had discontinued antipsychotics at year 20.