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Monotherapy vs. combination therapy for post mania maintenance treatment: A population based cohort study
Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol, T2, SE-17176 Stockholm, Sweden.
Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol, T2, SE-17176 Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol, T2, SE-17176 Stockholm, Sweden.ORCID iD: 0000-0002-2198-8842
Karolinska Inst, Karolinska Univ Hosp, Dept Med, Ctr Pharmacoepidemiol, T2, SE-17176 Stockholm, Sweden.
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2019 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 29, no 6, p. 691-700Article in journal (Refereed) Published
Abstract [en]

In recent years, the use of atypical antipsychotics and combination therapy for relapse prevention in bipolar disorder has increased substantially. However, real-world data on the comparative effectiveness of these treatment options are largely non-existent. We conducted a population-based cohort study, using data from Swedish national registers. All patients aged 18-75 years who were hospitalized for mania 2006-2014 and filled at least one prescription of lithium, valproate, olanzapine, quetiapine, aripiprazole or any combination of these drugs were included, and followed for up to one year after hospital discharge, generating follow-up data from 5 713 hospitalizations. We used Cox proportional hazard regression models to study time to treatment failure for each individual drug and combination therapy, using lithium as comparator. Treatment failure was defined as treatment discontinuation, switch, or rehospitalization, and the results were adjusted for clinical and sociodemographic factors. We found that treatment failure occurred in 85% of cases and that the majority of combination therapies were associated with lower risks of treatment failure compared to monotherapies. Patients combining lithium + valproate + quetiapine had the lowest risk of treatment failure (adjusted HR [AHR] 0.40, 95% CI 0.30-0.54), followed by patients on lithium + valproate + olanzapine (AHR 0.55, 95% CI 0.45-0.68). In contrast, monotherapies with antipsychotics were associated with significantly higher risks of treatment failure compared to single use of lithium. In conclusion, our results support experimental findings, suggesting that combination therapy is more effective than monotherapy after a manic episode.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV , 2019. Vol. 29, no 6, p. 691-700
Keywords [en]
Cohort studies, Bipolar disorder, Maintenance treatment, Antipsychotic agents, Lithium
National Category
Psychiatry Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:uu:diva-390038DOI: 10.1016/j.euroneuro.2019.04.003ISI: 000471165600001PubMedID: 31078359OAI: oai:DiVA.org:uu-390038DiVA, id: diva2:1340396
Funder
Swedish Research Council, 2016-02362Stiftelsen Söderström - Königska sjukhemmet, SLS-480131Fredrik och Ingrid Thurings Stiftelse, 2015-00114Novo Nordisk, NNF15SA0018404Swedish Society of Medicine, SLS-502541Swedish Society of Medicine, SLS-587661Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-08-05Bibliographically approved

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Bodén, Robert

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