High rates of antipsychotic switching in first episode psychosis (FEP) suggests first-line prescribing is less than optimal and does not follow recent clinical guidance.
In a large-scale, real-world analysis of UK prescribing patterns, researchers found more than two thirds of patients who received antipsychotics for FEP switched medication and almost half switched drugs three times.
Although this is "one of the largest real-world studies examining antipsychotic treatment strategies," it reflects findings from previous, smaller studies showing "antipsychotic switching in first episode psychosis is high," said study investigator Aimee Brinn, Institute of Psychiatry, Psychology & Neuroscience at King's College London in London, England.
This may reflect reports of poor efficacy and suggests that first-line prescribing is "suboptimal," Brinn noted. In addition, olanzapine remains the most popular antipsychotic for prescribing despite recent guidelines indicating it is "not ideal...due to its dangerous metabolic side effects," she added.
The findings were presented at the Congress of the Schizophrenia International Research Society (SIRS) 2022.
Real-World Data
The response to, and tolerability of, antipsychotics differs between patients with FEP; and prescribing patterns "reflect clinician and patient-led decision-making," Brinn told meeting attendees.
Since randomized controlled trials "do not necessarily reflect prescribing practice in real-world clinical settings," the researchers gathered data from a large mental health care electronic health record dataset.
