Real world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications

Barbosa, Wallace Breno and Gomes, Rosângela Maria and Godman, Brian and Acurcio, Francisco de Assis and Guerra Júnior, Augusto Afonso (2021) Real world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications. Expert Review of Clinical Pharmacology, 14 (2). pp. 269-279. ISSN 1751-2441

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    Abstract

    Introduction: Antipsychotics are widely prescribed for patients with schizophrenia. The Brazilian public health system provides these patients free of charge to patients and it is pertinent to evaluate their benefits. Objective: To evaluate the effectiveness of olanzapine and risperidone in the treatment of patients with schizophrenia in the real world and assessing risk factors for their discontinuation through a national non-concurrent cohort with 16 years of follow-up. Methods: Three SUS administrative databases were integrated by deterministic-probabilistic linkage. After, patients were matched (1:1) for psychiatric hospitalization, year of receiving the antipsychotic, sex and age, considering either olanzapine or risperidone at study entry. Kaplan-Meier was used to estimate the cumulative probabilities of discontinuation of treatment and associated factors were identified. Sensitivity analyzes were performed. Results: 3416 pairs of patients were included. Olanzapine had a longer time until discontinuation of treatment (p = 0.021), and risperidone had a higher risk of discontinuation (p = 0.021). Among patients persistent for at least 24 months, there was no statistically significant difference. Conclusion: Olanzapine demonstrated superior real-world effectiveness over risperidone, in terms of survival and psychiatric hospitalization. This superiority was not sustained in all analyzes.