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Comparative effectiveness of adaptive pharmacotherapy strategies for schizophrenia
Investigator (PI): Stroup, Thomas
Performing Organization (PO): (Current): New York State Psychiatric Institute / (646) 774-5000
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2015
Final Year: 2019
Record Source/Award ID: PCORI/CER-1310-06750
Funding: Total Award Amount: $1,453,361
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Schizophrenia is a severe mental disorder that affects approximately 2.4 million Americans. It typically begins in early adulthood and is a major cause of disability. The core treatment for schizophrenia is antipsychotic medication but the majority of individuals with schizophrenia are treated with more than one psychotropic medication simultaneously. Common additional treatments include benzodiazepines, antidepressants, mood stabilizers, and other antipsychotics. However, none of these treatment strategies have strong evidence to support their use. This investigation will address key patient-centered questions about medication strategies for individuals with schizophrenia who face common clinical situations; for example: I have schizophrenia and take an antipsychotic drug but still have symptoms that interfere with my daily life; I have schizophrenia and take an antipsychotic drug but often feel depressed. In these scenarios, a doctor may recommend a medication change--either a change in dose or a new medication. What patients want includes the following: What are my options? Which will best keep me out of the hospital? Which will help me to lead a long life? Which will help me avoid the emergency room? I'm worried about side effects--which option will help me avoid serious heart problems? Or diabetes? Objectives: The objectives are (1) within five clinically important schizophrenia subgroups, compare the effectiveness and safety of alternative medication strategies beyond antipsychotic monotherapy; (2) within the five schizophrenia subgroups, explore whether the comparative effectiveness and safety of alternative treatment strategies vary according to patient demographic and clinical characteristics; and (3) with extensive stakeholder input, interpret and prioritize study results and then integrate this information into dissemination efforts to maximize study impact. Method: We will work with patients, doctors, and other stakeholders to focus our research on outcomes that are meaningful. We will use ten years of national Medicaid data that is linked to mortality data to compare the benefits and risks of newly started medications for people with schizophrenia. The analyses will involve approximately 250,000 new medication starts for individuals who are already taking a single antipsychotic medication. Because a variety of factors affect which medications are selected for individual factors, we will use state-of-the-art methods to make sure the comparisons we make are valid. By determining which treatment options are most effective in achieving patient-centered outcomes for people with schizophrenia facing specific clinical problems, this project can reduce ineffective or even harmful medication practices and promote more personalized health care.
MeSH Terms:
  • Antipsychotic Agents /*therapeutic use
  • Comparative Effectiveness Research
  • Drug Therapy /methods
  • Humans
  • Medicaid
  • Outcome Assessment, Health Care
  • Patient Safety
  • Patient-Centered Care
  • Program Evaluation
  • Schizophrenia /*drug therapy
  • United States
Country: United States
State: New York
Zip Code: 10032
UI: 20153208
Project Status: Completed
Record History: ('2019: Project extended to 2019',)