Szmulewicz (2024)

Psychosis

Psychology • Other Data • US, Canada, Spain

View Paper Protocol

Study Metrics

Total Sample 1236

Treatment Group 853

Control Group 383

Covariates 13

PICO Comparisons 6

Quality Indicators

Transparency High

DAG Usage No

QBA Performed No

Study Information

First Author:	Szmulewicz
Publication Year:	2024
DOI:	https://doi.org/10.1093/aje/kwae029
Preprint:	No preprint

Institution & Funding

Institution Type:	Academic
Institutions:	Harvard T.H. Chan School of Public Health, Yale School of Medicine, University of Pittsburgh, University of British Columbia, New York University Grossman School of Medicine, Hospital General Universitario Gregorio Marañón, McLean Hospital, Harvard Medical School
Funding:	Declared: NGO
Funding Institutions:	A.G.S. was partly supported by a 2022 NARSAD Young Investigator Grant from the Brain and Behavior Research Foundation.

Study Context

Disease:	Psychosis
Disease Category:	Psychology
Data Type:	Other
Number of Data Sources:	8

Geography:	US, Canada, Spain
Eligible Sample:	1123.0
Number of Treatments:	6

Analytical Methods

Matching Method:	IPTW
Analysis Method:	Cox PH, Logistic regression
Estimand:	PP

Quality Methods

Directed Acyclic Graph (DAG) Not Used

Quantitative Bias Analysis (QBA) Not Performed

Target Trial Information

Target Trial Name:	EUFEST
Registration Number:	ISRCTN68736636
Target Trial DOI:	https://doi.org/10.1016/S0140-6736(08)60486-9

TTE vs RCT Comparisons

Detailed comparison between Target Trial Emulation results and corresponding Randomized Controlled Trial outcomes.

12-month risks of discontinuation

EUFEST

HR Efficacy

Population

Individuals aged 18-40 with a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder

Intervention

quetiapine 200-750 mg

Comparison

First-generation agents: haloperidol 5-10 mg, f luphenazine 2.5-40 mg, perphenazine 4-64 mg

Outcome

12-month risks of discontinuation

RCT Result

0.52

95% CI: [0.36, 0.76]

TTE Result

0.41

95% CI: [0.28, 0.59]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

Admission to hospital after intake

EUFEST

RR Efficacy

Population

Individuals aged 18-40 with a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder

Intervention

quetiapine 200-750 mg

Comparison

First-generation agents: haloperidol 5-10 mg, f luphenazine 2.5-40 mg, perphenazine 4-64 mg

Outcome

Admission to hospital after intake

RCT Result

1.05

95% CI: [0.80, 1.36]

TTE Result

1.11

95% CI: [0.78, 1.59]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

Co-prescription of antidepressants

EUFEST

RR Efficacy

Population

Individuals aged 18-40 with a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder

Intervention

quetiapine 200-750 mg

Comparison

First-generation agents: haloperidol 5-10 mg, f luphenazine 2.5-40 mg, perphenazine 4-64 mg

Outcome

Co-prescription of antidepressants

RCT Result

0.33

95% CI: [0.21, 0.54]

TTE Result

0.81

95% CI: [0.54, 1.21]

Concordance Assessment

Confidence Interval Overlap: No
CIs do not overlap

Direction Agreement: Same Direction
Both point to similar conclusion

Co-prescription of mood stabilizers

EUFEST

RR Efficacy

Population

Individuals aged 18-40 with a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder

Intervention

quetiapine 200-750 mg

Comparison

First-generation agents: haloperidol 5-10 mg, f luphenazine 2.5-40 mg, perphenazine 4-64 mg

Outcome

Co-prescription of mood stabilizers

RCT Result

1.00

95% CI: [0.77, 1.30]

TTE Result

1.74

95% CI: [1.03, 2.92]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Different Direction
Different conclusions

Overall functioning score (GAF)

EUFEST

MD Efficacy

Population

Individuals aged 18-40 with a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder

Intervention

quetiapine 200-750 mg

Comparison

First-generation agents: haloperidol 5-10 mg, f luphenazine 2.5-40 mg, perphenazine 4-64 mg

Outcome

Overall functioning score (GAF)

RCT Result

-0.10

95% CI: [-9.80, 9.70]

TTE Result

2.70

95% CI: [-3.84, 9.24]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Different Direction
Different conclusions

Severity of illness score (CGI-S)

EUFEST

MD Efficacy

Population

Individuals aged 18-40 with a diagnosis of schizophrenia, schizophreniform, or schizoaffective disorder

Intervention

quetiapine 200-750 mg

Comparison

First-generation agents: haloperidol 5-10 mg, f luphenazine 2.5-40 mg, perphenazine 4-64 mg

Outcome

Severity of illness score (CGI-S)

RCT Result

-0.10

95% CI: [-0.93, 0.73]

TTE Result

-0.50

95% CI: [-0.92, -0.08]

Concordance Assessment

Confidence Interval Overlap: Yes
CIs overlap, suggesting concordance

Direction Agreement: Same Direction
Both point to similar conclusion

Transparency Indicators

Protocol Registration Available

Data Sharing Not Available

Code Sharing Not Available

Overall Transparency Score:

High Transparency - This study meets good transparency standards.

Conflicts & Funding

Conflicts of Interest:	Declared: None
Funding Source:	Declared: NGO
Funding Institutions:	A.G.S. was partly supported by a 2022 NARSAD Young Investigator Grant from the Brain and Behavior Research Foundation.

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