Schizophrenia Bulletin Advance Access originally published online on November 5, 2007
Schizophrenia Bulletin 2008 34(1):13-14; doi:10.1093/schbul/sbm126
© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.
Cessation of Medication for People With Schizophrenia Already Stable on Chlorpromazine
Muhammad Qutayba Almerie1,2,
Hosam El-Din Matar2,
Adib Essali2,
Hassan Alkhateeb3 and
Emtithal Rezk2
2 The Continuing Professional Development Centre, Mezzah, Shaikh Saad, PO Box 11719, Damascus, Syria
3 Damascus Faculty of Medicine, Mezzah Avenue, Damascus, Syria
Keywords: schizophrenia / chlorpromazine / cessation
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Introduction
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People with schizophrenia are often encouraged to take medication
for protracted periods of time in order to postpone or stop
deterioration. It is, nevertheless, difficult for clinicians
to provide a quantitative estimate of risk of relapse should
medication be stopped. Because protracted use of any medication
carries a risk of adverse effects, it seems reasonable to seek
this evidence.
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Objectives
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To investigate the effects of stopping chlorpromazine for people
with schizophrenia already stable on that drug, primarily for
outcomes of global state, improvement, and relapse.
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Search Strategy
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We searched the Cochrane Schizophrenia Group Trials Register
(March 2006). This is compiled by systematic searches of major
databases, journals, and conference proceedings. We also inspected
references of all identified studies for further trials.
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Selection Criteria
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All clinical randomized controlled trials (RCTs) involving people
with schizophrenia comparing the withdrawal of chlorpromazine
with maintaining the medication.
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Data Collection and Analysis
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We independently inspected references located through electronic
or reference searches. Full texts of these articles were then
read, also independently, to decide whether they met our criteria.
Disagreement was resolved by discussion. We reliably assessed
study quality and extracted data. We used the relative risk
(RR) for dichotomous data and the weighted mean differences
for continuous data. Where heterogeneity existed (determined
by I-square test), a random effects model was used.
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Results
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We included 10 trials (total
N = 1042). People already stable
and maintained on chlorpromazine were found to experience significantly
less relapse compared with those who were asked to stop taking
their medication (
n = 850, 6 RCTs, RR relapse between 9 weeks
and 6 months 4.04 confidence interval [CI] 2.81 to 5.8, number
needed to harm (NNH) 4 CI 3 to 7;
n = 510, 3 RCTs, RR relapse
beyond 6 months 1.70 CI 1.44 to 2.01, NNH 4 CI 3 to 6). Even
in the short term, results showed a significant increase in
relapse rate of people who stopped medication (
n = 376, 3 RCTs,
RR relapse before 8 weeks 6.76 CI 3.37 to 13.54, NNH 4 CI 2
to 8) (see
figure 1). Regarding global state improvement, only
one study reported usable data at about 8 weeks favoring chlorpromazine
continuation (
n = 95, 1 RCT, RR not improved 2.46 CI 1.51 to
3.99, NNH 3 CI 2 to 8). More detailed findings are reported
in the full version of this review.
1
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Reviewer's Conclusion
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This review confirms much that clinicians already know but provides
quantification to support clinical impression.
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Implications for Practice
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For people with established illnesses, chlorpromazine withdrawal
shows significant increase in relapse across all time periods.
The epidemiology of schizophrenia consistently suggests that
over 10% of people with their first episode will not go on to
have further relapses. We did not find evidence to quantify
risk of stopping medication in those in their first episode
of schizophrenia. Relapse, however, incurs risks and costs that
would probably be judged by everyone as greater than those associated
with stable use of chlorpromazine.
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Implications for Research
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More reviews of trials focusing on cessation of other drugs
would provide opportunities for replication. New trials of drug
cessation for those at low risk of relapse may be possible to
justify.
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Footnotes |
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1 To whom correspondence should be addressed; tel: +963-11-666-6223, fax: +963-11-461-9902, e-mail: qutaybah83{at}hotmail.com.
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References
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- Almerie MQ, Alkhateeb H, Essali A, Matar HE, Rezk E. Cessation of medication for people with schizophrenia already stable on chlorpromazine. Cochrane Database Syst Rev (2007) (1):CD006329.
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Introduction
Objectives