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Psych Congress  

Prior hospitalization and treatment response in schizophrenia: a moderator analysis

Michael Tocco, PhD
Antony Loebel, MD
Cynthia Siu, PhD
Josephine Cucchiaro, PhD
Andrei Pikalov, MD, PhD
Steven Potkin, MD
Sunovion Pharmaceuticals Inc.

OBJECTIVE: Responsiveness to treatment has been associated with stages of illness in schizophrenia, with greater treatment response at earlier stages of illness. The objective of this study was to assess if diminished treatment re¬sponsiveness is associated with relapse and the number of prior hospitaliza-tions in schizophrenia. METHODS: A post-hoc analysis was performed on pooled data from three 6-week, double-blind, placebo-controlled trials for which prior hospitaliza¬tion and PANSS (LOCF) data were available. ANCOVA model was applied to compare mean changes from baseline in PANSS total among patients with and without prior hospitalization. RESULTS: In patients who had no prior hospitalization (n=158, 13.1%), treatment effect size (Cohen's d) was 0.85 (mean change -27.6 in the lurasidone group versus -12.1 in the placebo group). Treatment effects sizes were 0.34 in patients who had 1 prior hos¬pitalization (n=115, 9.6%), 0.46 in patients who had 2 prior hospitalizations (n=145, 12.1%), 0.38 in patients who had 3 prior hospitalizations (n=138, 11.5%), 0.34 in patients who had 4 or more prior hospitalizations (n=646, 53.7%). Statistical interaction test showed that the number of prior hospital¬izations was a moderating variable for treatment effect size (p<0.01). CONCLUSIONS: In this pooled lurasidone database analysis, patients with a history of prior hospitalization (and presumed relapse) in schizophrenia had diminished treatment effect size compared to those with no prior hospital¬ization. Number of past hospitalizations seems to moderate treatment responsiveness in patients with schizophrenia. These findings suggest that psychotic relapse may impair the ability to achieve optimal response in patients with schizophrenia.

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