Comparative effectiveness of mood stabiliser monotherapy versus second-generation antipsychotic monotherapy versus combination therapy for continuation and maintenance treatment after a first episode of psychotic mania in North America, Chile, and Spain: a target trial emulation using data from the BD-CAUSAL Collaboration.
Alejandro G Szmulewicz, Yu-Hsin Liang, Gonzalo Martínez-Alés et al.
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In 30 seconds
This pragmatic clinical trial evaluated the effectiveness of mood stabiliser monotherapy, second-generation antipsychotic monotherapy, and combination therapy in individuals aged 16 and older after a first episode of psychotic mania. Among 371 participants, the 2-year hospitalisation risk was 42.3% for mood stabiliser monotherapy, 49.5% for antipsychotic monotherapy, and 42.2% for combination therapy, indicating lower relapse risk with mood stabilisers compared to antipsychotics.
Key findings
- 42% of participants were hospitalised due to psychiatric reasons over a median of 19.8 months.
- The 2-year hospitalisation risk was 42.3% for mood stabiliser monotherapy and 49.5% for second-generation antipsychotic monotherapy.
- Mood stabiliser monotherapy had a lower risk of hospitalisation compared to second-generation antipsychotic monotherapy (risk difference -7.3%).
- Risks were similar between mood stabiliser monotherapy and combination therapy.
Why it matters
These findings suggest that mood stabilisers may be more effective than second-generation antipsychotics in preventing relapse after a first manic episode, which is crucial for improving long-term outcomes in bipolar disorder.