Change in level of productivity in the treatment of schizophrenia with olanzapine or other antipsychotics

Abstract

Background: When treating schizophrenia, improving patients' productivity level is a major goal considering schizophrenia is a leading cause of functional disability. Productivity level has been identified as the most preferred treatment outcome by patients with schizophrenia. However, little has been done to systematically investigate productivity levels in schizophrenia. We set out to better understand the change in productivity level among chronically ill patients with schizophrenia treated with olanzapine compared with other antipsychotic medications. We also assessed the links between productivity level and other clinical outcomes.

Methods: This post hoc analysis used data from 6 randomized, double-blind clinical trials of patients with schizophrenia or schizoaffective disorder, with each trial being of approximately 6 months duration. Change in productivity level was compared between olanzapine-treated patients (HGBG, n = 172; HGHJ, n = 277; HGJB, n = 171; HGLB, n = 281; HGGN, n = 159; HGDH, n = 131) and patients treated with other antipsychotic medications (separately vs. haloperidol [HGGN, n = 97; HGDH, n = 132], risperidone [HGBG, n = 167; HGGN, n = 158], quetiapine [HGJB, n = 175], ziprasidone [HGHJ, n = 271] and aripiprazole [HGLB, n = 285]). Productivity was defined as functional activities/work including working for pay, studying, housekeeping and volunteer work. Productivity level in the prior 3 months was assessed on a 5-point scale ranging from no useful functioning to functional activity/work 75% to 100% of the time.

Results: Chronically ill patients treated with olanzapine (OLZ) experienced significantly greater improvement in productivity when compared to patients treated with risperidone (RISP) (OLZ = 0.22 ± 1.19, RISP = -0.03 ± 1.17, p = 0.033) or ziprasidone (ZIP) (OLZ = 0.50 ± 1.38, ZIP = 0.25 ± 1.27, p = 0.026), but did not significantly differ from the quetiapine, aripiprazole or haloperidol treatment groups. Among first episode patients, OLZ therapy was associated with greater improvements in productivity levels compared to haloperidol (HAL), during the acute phase (OLZ = -0.31 ± 1.59, HAL = -0.69 ± 1.56, p = 0.011) and over the long-term (OLZ = 0.10 ± 1.50, HAL = -0.32 ± 1.91, p = 0.008). Significantly more chronically ill and first episode patients treated with olanzapine showed moderately high (>50%-75% of the time) and high levels of productivity (>75%-100% of the time) at endpoint, when compared to risperidone or haloperidol-treated patients (p < .05), respectively. Higher productivity level was associated with significantly higher study completion rates and better scores on the positive, negative, disorganized thoughts, hostility and depression subscales of the Positive and Negative Symptom Scale (PANSS).

Conclusions: Some antipsychotic medications significantly differed in beneficial impact on productivity level in the long-term treatment of patients with schizophrenia. Findings further highlight the link between clinical and functional outcomes, showing significant associations between higher productivity, lower symptom severity and better persistence on therapy.

Trial registration: clinicaltrials.gov identifier NCT00088049; NCT00036088.

Figures

Figure 1

By-study comparison of baseline-to-endpoint change in productivity level in olanzapine-treated versus other-treated chronically ill patients with schizophrenia. Comparison between olanzapine and each of the other antipsychotics--aripiprazole, haloperidol, risperidone, quetiapine, and ziprasidone--demonstrated that olanzapine was consistently associated with higher mean changes in baseline-to-endpoint productivity level. Productivity level was assessed by study investigators on a 5-point scale, with scale scores corresponding to how often functional activities can be performed: 1, no useful functioning; 2, > 0% to ≤25% of the time; 3, > 25% to ≤50% of the time; 4, > 50% to ≤75% of the time; and 5, >75% to ≤100% of the time. Abbreviations: ARI = aripiprazole, HAL = haloperidol, OLZ = olanzapine, RIS = risperidone, QUE = quetiapine, ZIP = ziprasidone. *HGBG, HGHJ -p < .05.

Figure 2

By-study comparison of endpoint productivity level in olanzapine-treated versus other-treated chronically ill patients with schizophrenia. Comparison between olanzapine and each of the other antipsychotics--aripiprazole, haloperidol, risperidone, quetiapine, and ziprasidone, more patients treated with olanzapine consistently had moderately high (>50% to 75% of the time) (a) and high productivity (>75% to 100% of the time) (b) at endpoint. Abbreviations: ARI = apripiprazole, HAL = haloperidol OLZ = olanzapine, RIS = risperidone, QUE = quetiapine, ZIP = ziprasidone. *HGBG -p < .05.

Figure 3

By-study comparison of mean productivity score of completers versus dropouts in chronically ill patients with schizophrenia treated with antipsychotics. Comparison between completers and dropouts showed that chronically ill patients who completed the studies had better productivity levels in each of the 5 studies. Abbreviations: ARI = aripiprazole, HAL = haloperidol, OLZ = olanzapine, RIS = risperidone, QUE = quetiapine, ZIP = ziprasidone. ** p < .001.

Figure 4

Comparison of baseline-to-endpoint change in productivity level in olanzapine-treated versus haloperidol-treated first episode patients with schizophrenia. Comparison between olanzapine and haloperidol demonstrated that olanzapine was consistently associated with higher mean changes in baseline-to-endpoint productivity level for both acute phase (first 12 weeks) and long-term phase (the following 24 weeks) treatment. Productivity level was assessed by study investigators on a 5-point scale, with scale scores corresponding to how often functional activities can be performed: 1, no useful functioning; 2, > 0% to ≤25% of the time; 3, > 25% to ≤50% of the time; 4, >50% to ≤75% of the time; and 5, >75% to ≤100% of the time. Abbreviations: HAL = haloperidol, OLZ = olanzapine. *HGDH-Acute, HGDH-Long-Term -p < .05.