Summary

This large Finnish cohort study compared mortality rates of patients with schizophrenia with the general population addressing concerns that second-generation antipsychotic drugs have adversely affected mortality due to increased risk of cardiovascular disease. This report found that long-term antipsychotic use in patients with schizophrenia was associated with reduced mortality compared with those who were not treated. Clozapine was associated with the lowest mortality risk (surprisingly, given safety concerns), and quetiapine with the highest.

Design

• Cohort study in Finland compared cause-specific mortality in patients with schizophrenia and related disorders (n=66,881) with the total population (n=5.2 million), from 1996 to 2006.
• All-cause mortality of patients with schizophrenia using antipsychotics were compared with those not using antipsychotics.
• Six most commonly used antipsychotics were compared with perphenazine.

Results

• Long-term use of any antipsychotic was associated with lower mortality than no antipsychotic use.
• Clozapine use was associated with significantly lower mortality risk than any other antipsychotic, and substantially lower suicide risk. The authors speculate that this may be due to increased effectiveness of clozapine, more intensive monitoring during treatment, or other factors.
• Second-generation antipsychotics as a proportion of all antipsychotic treatments:
  • 1996: 12.6%
  • 2006: 64.0%
• From 1996 to 2006, life expectancy at age 20 rose by 2.4 years in the general population and 4.9 years in patients with schizophrenia. This represents a slight narrowing of the significant gap in life expectancy between these groups (25 years in 1996, 22.5 years in 2006).
• Risk of death from ischemic heart disease did not differ significantly between antipsychotic drug used.

Reference

Tiihonen J, Lönnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet. 2009;374(9690):620–627.