Real-world Effectiveness of Pharmacological Treatment

Research topics and goals

Nowadays, most treatment guidelines are largely based on randomized controlled trials (RCTs), but also observational studies can give important contribution to evidence-based medicine. The patient populations in RCTs are highly selected, and follow-up periods are short and, therefore, the generalization of RCTs to real-world settings is questionable. Also, studying infrequent phenomena, such as death and suicide, is practically impossible in RCTs. We study the real-world effectiveness of psychopharmacological treatments of psychoses and depression by using nationwide hospital discharge, prescription and mortality registers.
We have shown that in the treatment of schizophrenia, use of antipsychotic is associated with decreased mortality compared with no use of antipsychotic, and clozapine is associated with lower mortality than other antipsychotics. We have also observed that benzodiazepine use is linked with increased mortality, whereas use of an antidepressant or several concomitant antipsychotics is not. In first episode patients, use of depot antipsychotic injections leads to decreased risk of rehospitalization.
Now we are studying the effectiveness of antipsychotics, mood stabilizers, and antidepressants in the relapse and suicide prevention in bipolar disorders.

Latest achievements

• Welfare and health: The publications concerning pharmacoepidemiology have already had international influence to treatment guidelines concerning schizophrenia (Kunskapcentrum för hälso- och sjukvården, SBU, Sweden; Skitsofrenian Käypä hoito-suositus, Finland).

Research methods

• Real-world effectiveness of treatments by using nationwide hospital discharge, prescription and mortality registers.

Group – Postdocs

• Reseacher Markku Lähteenvuo, markku.lahteenvuo(at)niuva.fi

Group – Technicians

• Project manager Antti Tanskanen, antti.tanskanen(at)ki.se

Collaboration:

• Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden

Selected publications

• Tiihonen J, Haukka J, Taylor M, Haddad PM, Patel MX, Korhonen P. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry 2011 Jun;168(6):603-9.

• Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry 2012 May;69(5):476-83.

• Tiihonen J, Mittendorfer-Rutz E, Torniainen M, Alexanderson K, Tanskanen A: Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia: an observational follow-up study. Am J Psychiatry 2016 Jun 1;173(6):600-6.

• Tiihonen J, Tanskanen A, Hoti F, Vattulainen P, Taipale H, Mehtälä J, Lähteenvuo M. Pharmacological treatments and risk of readmission to hospital for unipolar depression in Finland: a nationwide cohort study. Lancet Psychiatry 2017 Jul;4(7):547-553.

• Tiihonen J, Mittendorfer-Rutz E, Majak M, Mehtälä J, Hoti F, Jedenius E, Enkusson D, Leval A, Sermon J, Tanskanen A, Taipale H. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017 Jul 1;74(7):686-693.

• Lähteenvuo M, Tanskanen A, Taipale H, Hoti F, Vattulainen P, Vieta E, Tiihonen J: Real-world effectiveness of pharmacologic treatments for the prevention of rehospitalization in a Finnish nationwide cohort of patients with bipolar disorder. JAMA Psychiatry 2018;Apr 1;75(4):347-355.

• Tiihonen J, Tanskanen A, Taipale H: 20-year nationwide follow-up study on discontinuation of antipsychotic treatment in first-episode schizophrenia. Am J Psychiatry 2018 Aug 1;175(8):765-773.

• Tiihonen J, Taipale H, Mehtälä J, Vattulainen P, Correll CU, Tanskanen A: Association of antipsychotic polypharmacy vs. monotherapy with psychiatric rehospitalization among adults with schizophrenia. JAMA Psychiatry 2019 May 1;76(5):499-507.

• Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J: 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020 Feb;19(1):61-68.