Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-18T23:47:29.710Z Has data issue: false hasContentIssue false
  • English
  • Français

Recurrence rates in stable bipolar disorder patients after drug discontinuation v. drug maintenance: a systematic review and meta-analysis

Published online by Cambridge University Press:  13 October 2020

Taro Kishi Open the ORCID record for Taro Kishi [Opens in a new window] ,
Yuki Matsuda ,
Kenji Sakuma ,
Makoto Okuya ,
Kazuo Mishima  and
Nakao Iwata
Taro Kishi*
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi470-1192, Japan
Yuki Matsuda
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
Kenji Sakuma
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi470-1192, Japan
Makoto Okuya
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi470-1192, Japan
Kazuo Mishima
Affiliation:
Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
Nakao Iwata
Affiliation:
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi470-1192, Japan
*
Author for correspondence: Taro Kishi, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This random-effects model meta-analysis of double-blind, randomized placebo-controlled trials compared recurrence rates in bipolar disorder (BD) patients between antipsychotic/mood stabilizer discontinuation and maintenance groups.

Methods

We conducted systematic literature search of Embase, PubMed, and CENTRAL databases without language restriction from inception until 22 May 2020. Independent investigators assessed studies and extracted data. We calculated risk ratios (RRs) and numbers needed to benefit or harm (NNTB/NNTH). Primary outcome was the recurrence rate of any mood episode at 6 months. Secondary outcomes were recurrence rates of depressive episodes and manic/hypomanic/mixed episodes and all-cause discontinuation at 6 months. We also investigated these outcomes at 1, 3, 9, 12, 18, and 24 months.

Results

We identified 22 studies (n = 5462) receiving aripiprazole, asenapine, divalproex, long-acting injectable (LAI)-aripiprazole, LAI-risperidone, lamotrigine, lithium, olanzapine, paliperidone, or quetiapine. Mean study duration was 64.50 ± 69.35 weeks. The maintenance group demonstrated lower recurrence rates of any mood episode, depressive episodes, and manic/hypomanic/mixed episodes as well as reduced all-cause discontinuation at every observational point. The RRs (95% confidence interval, NNTB/NNTH) of recurrence rate at 6 months were 0.61 (0.54–0.70, 5) for any mood episode, 0.72 (0.60–0.87, 13) for depressive episodes, and 0.45 (0.36–0.57, 6) for manic/hypomanic/mixed episodes. The RR for all-cause discontinuation at 6 months was 0.71 (0.61–0.82, 6).

Conclusions

Maintaining drug treatment during clinically stable BD prevented recurrence for up to 24 months. Discontinuation of medications for ⩾1 month significantly increased recurrence risk. However, 47.3% of patients who discontinued drugs for 6 months did not experience recurrence.

Keywords

Antipsychoticsmood stabilizerrecurrence ratesystematic review and meta-analysisdouble-blind, randomized placebo-controlled trials
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 15 , November 2021 , pp. 2721 - 2729
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The online version of this article has been updated since original publication. A notice detailing the changes has also been published at https://doi.org/10.1017/S0033291721001033

References

Amsterdam, J. D., & Shults, J. (2010). Efficacy and safety of long-term fluoxetine versus lithium monotherapy of bipolar II disorder: A randomized, double-blind, placebo-substitution study. The American Journal of Psychiatry, 167(7), 792–800. doi: 10.1176/appi.ajp.2009.09020284.CrossRefGoogle ScholarPubMed
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57(1), 289–300.CrossRefGoogle Scholar
Berwaerts, J., Melkote, R., Nuamah, I., & Lim, P. (2012). A randomized, placebo- and active-controlled study of paliperidone extended-release as maintenance treatment in patients with bipolar I disorder after an acute manic or mixed episode. Journal of Affective Disorders, 138(3), 247–258. doi: 10.1016/j.jad.2012.01.047.CrossRefGoogle ScholarPubMed
Blonde, L., Khunti, K., Harris, S. B., Meizinger, C., & Skolnik, N. S. (2018). Interpretation and impact of real-world clinical data for the practicing clinician. Advances in Therapy, 35(11), 1763–1774. doi: 10.1007/s12325-018-0805-y.CrossRefGoogle ScholarPubMed
Bowden, C. L., Calabrese, J. R., McElroy, S. L., Gyulai, L., Wassef, A., Petty, F., … Wozniak, P. J. (2000). A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Archives of General Psychiatry, 57(5), 481–489. doi: 10.1001/archpsyc.57.5.481.CrossRefGoogle ScholarPubMed
Bowden, C. L., Calabrese, J. R., Sachs, G., Yatham, L. N., Asghar, S. A., Hompland, M., … Lamictal 606 Study, G. (2003). A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Archives of General Psychiatry, 60(4), 392–400. doi:10.1001/archpsyc.60.4.392.CrossRefGoogle ScholarPubMed
Calabrese, J. R., Bowden, C. L., Sachs, G., Yatham, L. N., Behnke, K., Mehtonen, O. P., … Lamictal 605 Study, G. (2003). A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. The Journal of Clinical Psychiatry, 64(9), 1013–1024. doi:10.4088/jcp.v64n0906.CrossRefGoogle ScholarPubMed
Calabrese, J. R., Sanchez, R., Jin, N., Amatniek, J., Cox, K., Johnson, B., … Carson, W. H. (2017). Efficacy and safety of aripiprazole once-monthly in the maintenance treatment of bipolar I disorder: A double-blind, placebo-controlled, 52-week randomized withdrawal study. The Journal of Clinical Psychiatry, 78(3), 324–331. doi: 10.4088/JCP.16m11201.CrossRefGoogle ScholarPubMed
Calabrese, J. R., Suppes, T., Bowden, C. L., Sachs, G. S., Swann, A. C., McElroy, S. L., … Monaghan, E. T. (2000). A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. The Journal of Clinical Psychiatry, 61(11), 841–850. doi: 10.4088/jcp.v61n1106.CrossRefGoogle ScholarPubMed
Cundall, R. L., Brooks, P. W., & Murray, L. G. (1972). A controlled evaluation of lithium prophylaxis in affective disorders. Psychological Medicine, 2(3), 308–311. doi: 10.1017/s0033291700042616.CrossRefGoogle ScholarPubMed
DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188.CrossRefGoogle ScholarPubMed
Dunner, D. L., Stallone, F., & Fieve, R. R. (1976). Lithium carbonate and affective disorders. V: A double-blind study of prophylaxis of depression in bipolar illness. Archives of General Psychiatry, 33(1), 117–120. doi: 10.1001/archpsyc.1976.01770010073014.CrossRefGoogle ScholarPubMed
Fieve, R. R., Kumbaraci, T., & Dunner, D. L. (1976). Lithium prophylaxis of depression in bipolar I, bipolar II, and unipolar patients. The American Journal of Psychiatry, 133(8), 925–929. doi: 10.1176/ajp.133.8.925.Google ScholarPubMed
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. Lancet (London, England), 387(10027), 1561–1572. doi: 10.1016/S0140-6736(15)00241-X.CrossRefGoogle ScholarPubMed
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ: British Medical Journal, 327(7414), 557–560. doi: 10.1136/bmj.327.7414.557.CrossRefGoogle ScholarPubMed
Kane, J. M., Quitkin, F. M., Rifkin, A., Ramos-Lorenzi, J. R., Nayak, D. D., & Howard, A. (1982). Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness: A prospective, placebo-controlled comparison. Archives of General Psychiatry, 39(9), 1065–1069. doi: 10.1001/archpsyc.1982.04290090053011.CrossRefGoogle ScholarPubMed
Keck, P. E. Jr., Calabrese, J. R., McIntyre, R. S., McQuade, R. D., Carson, W. H., Eudicone, J. M., … Aripiprazole Study, G. (2007). Aripiprazole monotherapy for maintenance therapy in bipolar I disorder: A 100-week, double-blind study versus placebo. The Journal of clinical psychiatry, 68(10), 1480–1491. doi:10.4088/jcp.v68n1003.CrossRefGoogle ScholarPubMed
Kishi, T., Oya, K., & Iwata, N. (2016). Long-acting injectable antipsychotics for prevention of relapse in bipolar disorder: A systematic review and meta-analyses of randomized controlled trials. The International Journal of Neuropsychopharmacology, 19(9), pyw038. doi: 10.1093/ijnp/pyw038.CrossRefGoogle ScholarPubMed
Koyama, T., Higuchi, T., Yamawaki, S., Kanba, S., Terao, T., & Shinohara, A. (2011). Study SCA104779, an evaluation of BW430C (lamotrigine) versus placebo in the prevention of mood episodes in bipolar I disorder patients. Japanese Journal of Clinical Psychiatry, 40(3), 369–383.Google Scholar
Lahteenvuo, M., Tanskanen, A., Taipale, H., Hoti, F., Vattulainen, P., Vieta, E., & Tiihonen, J. (2018). Real-world effectiveness of pharmacologic treatments for the prevention of rehospitalization in a finnish nationwide cohort of patients with bipolar disorder. JAMA Psychiatry, 75(4), 347–355. doi: 10.1001/jamapsychiatry.2017.4711.CrossRefGoogle Scholar
Melia, P. I. (1970). Prophylactic lithium: A double-blind trial in recurrent affective disorders. The British Journal of Psychiatry: The Journal of Mental Science, 116(535), 621–624. doi: 10.1192/bjp.116.535.621.CrossRefGoogle ScholarPubMed
Miura, T., Noma, H., Furukawa, T. A., Mitsuyasu, H., Tanaka, S., Stockton, S., … Kanba, S. (2014). Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: A systematic review and network meta-analysis. The Lancet. Psychiatry, 1(5), 351–359. doi: 10.1016/S2215-0366(14)70314-1.CrossRefGoogle ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ: British Medical Journal, 339, b2535. doi: 10.1136/bmj.b2535.CrossRefGoogle ScholarPubMed
Prien, R. F., Caffey, E. M. Jr., & Klett, C. J. (1973). Prophylactic efficacy of lithium carbonate in manic-depressive illness. Report of the Veterans Administration and National Institute of Mental Health collaborative study group. Archives of General Psychiatry, 28(3), 337–341. doi:10.1001/archpsyc.1973.01750330035006.CrossRefGoogle ScholarPubMed
Prien, R. F., Klett, C. J., & Caffey, E. M. Jr. (1973). Lithium carbonate and imipramine in prevention of affective episodes. A comparison in recurrent affective illness. Archives of General Psychiatry, 29(3), 420–425. doi:10.1001/archpsyc.1973.04200030104017.CrossRefGoogle ScholarPubMed
Quiroz, J. A., Yatham, L. N., Palumbo, J. M., Karcher, K., Kushner, S., & Kusumakar, V. (2010). Risperidone long-acting injectable monotherapy in the maintenance treatment of bipolar I disorder. Biological Psychiatry, 68(2), 156–162. doi: 10.1016/j.biopsych.2010.01.015.CrossRefGoogle ScholarPubMed
Szegedi, A., Durgam, S., Mackle, M., Yu, S. Y., Wu, X., Mathews, M., & Landbloom, R. P. (2018). Randomized, double-blind, placebo-controlled trial of asenapine maintenance therapy in adults with an acute manic or mixed episode associated with bipolar I disorder. The American Journal of Psychiatry, 175(1), 71–79. doi: 10.1176/appi.ajp.2017.16040419.CrossRefGoogle ScholarPubMed
Tohen, M., Calabrese, J. R., Sachs, G. S., Banov, M. D., Detke, H. C., Risser, R., … Bowden, C. L. (2006). Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. The American Journal of Psychiatry, 163(2), 247–256. doi: 10.1176/appi.ajp.163.2.247.CrossRefGoogle ScholarPubMed
Vieta, E., Montgomery, S., Sulaiman, A. H., Cordoba, R., Huberlant, B., Martinez, L., & Schreiner, A. (2012). A randomized, double-blind, placebo-controlled trial to assess prevention of mood episodes with risperidone long-acting injectable in patients with bipolar I disorder. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 22(11), 825–835. doi: 10.1016/j.euroneuro.2012.03.004.CrossRefGoogle ScholarPubMed
Weisler, R. H., Nolen, W. A., Neijber, A., Hellqvist, A., Paulsson, B., & Trial 144 Study, I. (2011). Continuation of quetiapine versus switching to placebo or lithium for maintenance treatment of bipolar I disorder (trial 144: A randomized controlled study). The Journal of Clinical Psychiatry, 72(11), 1452–1464. doi:10.4088/JCP.11m06878.CrossRefGoogle Scholar
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. doi: 10.1111/bdi.12609.CrossRefGoogle ScholarPubMed
Young, A. H., McElroy, S. L., Olausson, B., Paulsson, B., Embolden, I., & Embolden, I. I. I. (2014). A randomised, placebo-controlled 52-week trial of continued quetiapine treatment in recently depressed patients with bipolar I and bipolar II disorder. The World Journal of Biological Psychiatry, 15(2), 96–112. doi: 10.3109/15622975.2012.665177.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Kishi et al. supplementary material

Kishi et al. supplementary material

Download Kishi et al. supplementary material(PDF)
PDF 1.2 MB