Antipsychotic use lowers work disability risk

Use of antipsychotics, particularly long-acting injectables, results in nearly 30‒50-percent reduced risk of work disability among individuals with first-episode nonaffective psychosis compared with nonuse, a study has shown. This benefit persists beyond 5 years after first diagnosis.

Using a within-subject design, the authors assessed the risk of sickness absence or disability pension during antipsyhotic use compared with nonuse during a maximum of 11 years of follow-up (2006‒2016) in a Swedish nationwide cohort of patients with first-episode noneffective psychosis (n=21,551; aged 16‒45 years).

Stratified Cox regression models were used, adjusted for time-varying factors, to perform within-subject analyses, using each individual as his or her own control to eliminate selection bias. Work disability (ie, sickness absence or disability pension) was the primary outcome.

During a median follow-up of 4.8 years, less than half of the first-episode patients (45.9 percent) had work disability. Use of any antipsychotic therapy resulted in a lower risk of work disability compared with nonuse (adjusted hazard ratio [aHR], 0.65, 95 percent confidence interval [CI], 0.59‒0.72).

The lowest adjusted HRs were observed with long-acting injectable antipsychotics (aHR, 0.46, 95 percent CI, 0.34‒0.62), oral aripiprazole (aHR, 0.68, 95 percent CI, 0.56‒0.82), and oral olanzapine (aHR, 0.68, 95 percent CI, 0.59‒0.78). Of note, long-acting injectables correlated with a lower risk than olanzapine, the most common oral antipsychotic (aHR, 0.68, 95 percent CI, 0.50‒0.94).

Adjusted HRs were similar during the following periods: <2 years, 2‒5 years, and >5 years since diagnosis.

“These findings are informative regarding the important topic of early discontinuation of antipsychotic treatment after a first episode of nonaffective psychosis, but they need replication,” the authors said.