Taipale H, et al. - The researchers performed this study to investigate whether antipsychotic treatment was correlated with increased or decreased mortality among patients with schizophrenia. Furthermore, they aimed to examine if there were any clinically meaningful differences between specific agents and routes of administration. Long-acting injection (LAI) use was correlated with an approximately 30% lower risk of death compared with oral agents among patients with schizophrenia. Second generation (SG) LAIs and oral aripiprazole were associated with the lowest mortality.

Methods

• During 2006-2013, the researchers linked prospectively gathered nationwide register-based data to study all-cause mortality among all patients aged 16-64 years with schizophrenia in Sweden (N = 29,823 in total; N = 4603 in the incident cohort).
• They adjusted multivariate Cox regression models for clinical and sociodemographic covariates.
• They conducted sensitivity analyses with the incident cohort to control for survival bias.

Results

• A total of 2,515 patients (8.4%) died during the mean follow-up of 5.7 years.
• The lowest cumulative mortality was observed for second generation (SG) long-acting injection (LAI) use (7.5%), during the maximum follow-up (7.5 years).
• For first generation (FG) LAIs, adjusted hazard ratios (aHRs) compared to SG LAI use were 1.37 (95%CI 1.01-1.86), 1.52 (1.13-2.05) for SG orals, 1.83 (1.33-2.50) for FG orals, and 3.39 (2.53-4.56) for nonuse of antipsychotics.
• Regarding specific agents, the lowest mortality was observed for once-monthly paliperidone LAI (0.11, 0.03-0.43), oral aripiprazole (0.22, 0.15-0.34), and risperidone LAI (0.31, 0.23-0.43).
• LAIs were correlated with 33% lower mortality than equivalent orals (0.67, 0.56-0.80), in pairwise comparison.
• As per findings, the outcomes with incident cohort were consistent with the primary analyses.