Background: Optimization of long-term treatment of schizophrenia often involves consideration of changing antipsychotic (AP) medications. The actual decision whether to switch APs is influenced by prescriber practices and patient preferences.
Objective: To characterize factors influencing AP switching in adult patients with schizophrenia. Method: Health care providers (HCPs) treating adults with schizophrenia were surveyed at a major psychopharmacology meeting. The questions were presented to 141 HCPs (predominantly practicing psychiatrists). Questions sought to characterize: proportion of patients requiring a switch; therapeutic setting of AP switching; factors prompting switching; methods to monitor safety and tolerability; and description of switching strategies. Key Findings: Half the respondents (59/117) indicated that 25%-50% of adults with schizophrenia require a change in AP treatment; 48% (60/124) reported that AP switching occurs primarily in the outpatient setting. Among HCPs, 81% (96/118) collaborate with patients before making a decision to switch. HCPs most often switch AP treatment due to lack of efficacy (68%, 81/120), whereas patients are more likely to pursue a switch due to safety or tolerability concerns (63%, 80/126), mainly because of weight gain and/or cardiometabolic changes. A variety of switching strategies are used by HCPs with no single method identified by a majority of them.
Conclusion: These findings suggest a variety of factors influencing AP switching in schizophrenia. HCPs and patients may be prompted to switch for different reasons, and the decision is most often collaborative. The findings support a need for further research and physician education on optimization of switching strategies in an outpatient setting.