TY - JOUR
T1 - Associations of comorbid substance use disorders with clinical outcomes in schizophrenia using electronic health record data
AU - Patel, Rashmi
AU - Chan, Kelly MY
AU - Palmer, Emily OC
AU - Valko, Matthew
AU - Guruswamy, Guruprabha
AU - Ker, Sheryl
AU - Batra, Gunjan
AU - Rentería, Miguel E
AU - Kollins, Scott H.
N1 - Funding Information:
All authors report current or previous employment with Holmusk Technologies, Inc. RP has received grant funding from the National Institute of Health Research ( NIHR301690 ), the Medical Research Council ( MR/S003118/1 ), the Academy of Medical Sciences ( SGL015/1020 ) and Janssen , and consulting fees from Holmusk, Akrivia Health, Columbia Data Analytics, Otsuka and Boehringer Ingelheim.
Funding Information:
The present study was sponsored by Holmusk Technologies, Inc.
Funding Information:
The present study was sponsored by Holmusk Technologies, Inc.All authors report current or previous employment with Holmusk Technologies, Inc. RP has received grant funding from the National Institute of Health Research (NIHR301690), the Medical Research Council (MR/S003118/1), the Academy of Medical Sciences (SGL015/1020) and Janssen, and consulting fees from Holmusk, Akrivia Health, Columbia Data Analytics, Otsuka and Boehringer Ingelheim.
Publisher Copyright:
© 2023 The Authors
PY - 2023/9/11
Y1 - 2023/9/11
N2 - Background and hypothesis: Schizophrenia and comorbid substance use disorders (SUDs) are associated with poor treatment outcomes but differences between the associations of different SUDs with clinical outcomes are poorly characterized. This study examines the associations of comorbid SUDs with clinical outcomes in schizophrenia using a largescale electronic health record (EHR) database. Design: Real-world data (RWD) analysis using the NeuroBlu database; de-identified EHR data were analysed. Multivariable logistic regression, Poisson and CoxPH models were used to compare the associations of specific comorbid SUDs with outcome variables. Results: Comorbid SUD was significantly different on all outcome measures compared to no SUD (U = 1.44e
7–1.81e
7, all ps < .001), except number of unique antipsychotics (U = 1.61e
7, p = .43). Cannabis (OR = 1.58, p < .001) and polysubstance (OR = 1.22, p = .007) use disorders were associated with greater CGI-S. Cannabis (IRR = 1.13, p = .003) and polysubstance (IRR = 1.08, p = .003) use disorders were associated with greater number of unique antipsychotics prescribed, while cocaine (HR = 1.87, p < .001), stimulants (HR = 1.64, p = .024), and polysubstance (HR = 1.46, p < .001) use disorders were associated with a shorter time to antipsychotic discontinuation. Conversely, alcohol use (IRR = 0.83, p < .001), cocaine use (IRR = 0.61, p < .001), opioid use (IRR = 0.61, p < .001), stimulant use (IRR = 0.57, p < .001) and polysubstance use (IRR = 0.87, p < .001) disorders were associated fewer inpatient days. Conclusion: Comorbid SUDs were generally associated with greater CGI-S and poorer clinical outcomes in patients with schizophrenia. Treatment strategies should target not only schizophrenia symptoms but also comorbid SUD to improve management of both conditions.
AB - Background and hypothesis: Schizophrenia and comorbid substance use disorders (SUDs) are associated with poor treatment outcomes but differences between the associations of different SUDs with clinical outcomes are poorly characterized. This study examines the associations of comorbid SUDs with clinical outcomes in schizophrenia using a largescale electronic health record (EHR) database. Design: Real-world data (RWD) analysis using the NeuroBlu database; de-identified EHR data were analysed. Multivariable logistic regression, Poisson and CoxPH models were used to compare the associations of specific comorbid SUDs with outcome variables. Results: Comorbid SUD was significantly different on all outcome measures compared to no SUD (U = 1.44e
7–1.81e
7, all ps < .001), except number of unique antipsychotics (U = 1.61e
7, p = .43). Cannabis (OR = 1.58, p < .001) and polysubstance (OR = 1.22, p = .007) use disorders were associated with greater CGI-S. Cannabis (IRR = 1.13, p = .003) and polysubstance (IRR = 1.08, p = .003) use disorders were associated with greater number of unique antipsychotics prescribed, while cocaine (HR = 1.87, p < .001), stimulants (HR = 1.64, p = .024), and polysubstance (HR = 1.46, p < .001) use disorders were associated with a shorter time to antipsychotic discontinuation. Conversely, alcohol use (IRR = 0.83, p < .001), cocaine use (IRR = 0.61, p < .001), opioid use (IRR = 0.61, p < .001), stimulant use (IRR = 0.57, p < .001) and polysubstance use (IRR = 0.87, p < .001) disorders were associated fewer inpatient days. Conclusion: Comorbid SUDs were generally associated with greater CGI-S and poorer clinical outcomes in patients with schizophrenia. Treatment strategies should target not only schizophrenia symptoms but also comorbid SUD to improve management of both conditions.
UR - http://www.scopus.com/inward/record.url?scp=85169933500&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2023.08.023
DO - 10.1016/j.schres.2023.08.023
M3 - Article
SN - 0920-9964
VL - 260
SP - 191
EP - 197
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -
