This study quantified the risk and predictors of relapse among individuals with schizophrenia withdrawn from antipsychotic maintenance treatment. Using data from five randomized trials with 688 participants (173 on oral antipsychotics [OAPs] and 515 on long-acting injectables [LAIs]), the study employed survival and Cox-regression analyses to estimate relapse rates and predictors. Results showed 29.9% remained relapse-free by follow-up, with OAP-stabilized individuals having a lower relapse-free rate compared with those stabilized on LAIs. The overall relapse rate was 45.2%, with OAP-stabilized individuals experiencing higher rates than those on LAIs.

Predictors of relapse included smoking, female sex, and being stabilized on OAPs instead of LAIs, with a significantly higher relapse risk for OAP-stabilized participants. Even after enough time for plasma antipsychotic levels to clear, relapse risk remained higher for those on OAPs. “Rebound psychosis” showed no significant predictors. The findings highlight the high relapse risk after antipsychotic withdrawal and suggest that LAIs reduce the short- to medium-term relapse risk.

Reference: Schoretsanitis G, Kane JM, Correll CU, Rubio JM. Predictors of Lack of Relapse After Random Discontinuation of Oral and Long-acting Injectable Antipsychotics in Clinically Stabilized Patients with Schizophrenia: A Re-analysis of Individual Participant Data. Schizophr Bull. 2022;48(2):296-306. doi: 10.1093/schbul/sbab091.