(300) Antipsychotics in treatment of adolescents with schizophrenia in China

Background: Navigating treatment for adolescent schizophrenia is challenging given the scarcity of available guidelines and is often based on adult practice. Understanding the current practice of antipsychotics [AP] utilization among Chinese adolescent patients is imperative to inform appropriate use in this population.

Objectives: To describe current landscape of AP utilization in adolescents with schizophrenia in China.

Methods: This retrospective cohort study used electronic medical records (2018-2022) from a psychiatry hospital (PH) and a general hospital (GH) in China. Adolescent patients (12-17y) with a schizophrenia diagnosis (ICD-10: F20.x) who were prescribed oral AP during the study period were included. Index date was defined as the date of the first identified AP prescription. Patients were followed up until the last AP prescription, age of 18, or end of the study period, whichever was the earliest. AP utilization including treatment duration (sum duration of episode, which is a continuous period of AP use with gap not exceeding 60 days), proportion and number of different AP prescribed, polypharmacy (>=2 APs for over 60 days) and dosage during treatment were described. Dosage was described separately for outpatient and inpatient prescriptions and converted using DDD for unified measurement and using adults as the reference.

Results: Overall, 869 (mean age: 15.6y, male 50.6%) and 618 (mean age: 16.1y, male 50.7%) patients were included in PH and GH, respectively. During the mean treatment durations of 245.3 days (1.5 episodes) and 255.7 days (1.4 episodes), patients had prescribed 2.1 (SD 1.20) and 1.6 (SD 0.94) different APs on average. Most patients (99.6% and 100.0%) prescribed SGA and few (4.1% and 4.2%) prescribed FGA. The top three APs frequently prescribed by individuals were aripiprazole (50.5%), olanzapine (38.5%), risperidone (34.4%) in PH, and aripiprazole (35.8%), risperidone (29.0%), paliperidone (27.8%) in GH. Not many patients had polypharmacy (32.3% and 11.5%), among them, mean duration of polypharmacy were 265.9 (SD 249.51) days and 212.9 (SD 174.0) days with an average of 1.25 and 1.17 times observed, respectively. The average daily dose of AP was 0.6 (SD 0.24) DDDs and 0.7 (SD 0.38) DDDs at inpatient, while at outpatient setting it was 0.8 (SD 0.44) DDDs and 1.0 (SD 0.54) DDDs.

Conclusions: In Chinese adolescent patients, SGA is the mainstream in treatment with majority prescribed as monotherapy. Polypharmacy of AP use is observed with a steady pattern during the study period. In general, APs were prescribed with equal or reduced dose compared to adults. This study provides insight on current landscape of AP utilization of adolescent schizophrenia patients, which could benefit improving appropriate AP use in this population in the future.