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Commentary on: Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017;74:686–693.
What is already known on this topic
It is essential to identify differences in efficacy and effectiveness between antipsychotic options to inform treatment decisions in schizophrenia. Presence or absence of superiority has recently been particularly controversial for clozapine and long-acting injectable antipsychotics (LAIs), triggered by contrasting positive, negative and inconsistent meta-analyses of randomised controlled trials (RCTs).1–4 These inconsistencies may have been largely the result of selection bias since patients enrolled in RCTs may have a less severe illness, more insight, greater adherence and an overall better prognosis.4 This selection bias may be particularly important for clozapine and LAIs, which may be most effective in treatment-resistant patients and those with greater likelihood of non-adherence-related poor outcomes.
Methods of the study
The authors conducted a cohort study of all the patients with a diagnosis of schizophrenia between 1 July 2006 and 31 December 2013 in Sweden, studying separately the cohort of patients who received a new diagnosis of schizophrenia during the study period.5 The intervention was the prescribed pharmacological treatment, obtained from …
Competing interests JMR has been an advisor for Lundbeck. CUC has been a consultant and/or advisor to or has received honoraria from Alkermes, Allergan, Angelini, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, Medavante, Medscape, Merck, Neurocrine, Otsuka, Pfizer, ROVI, Servier, Sunovion, Takeda and Teva. He has provided expert testimony for Bristol-Myers Squibb, Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, ROVI and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a shareholder of LB Pharma.
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Provenance and peer review Commissioned; internally peer reviewed.
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