OBJECTIVES : Patients with schizophrenia receive multiple treatments along the course of their chronic disease. Several guidelines recommend to consider an alternative treatment if current one does not provide the expected efficacy. The “ideal” treatment controls both positive and negative symptoms and preserves patient’s functionality. First and second generation antipsychotics have different dopaminergic, serotoninergic or adrenergic receptor activities and affinities. They are equally recommended but neither of them seem to cover “ideal” criteria fully, which added to potential side effects, may led to a non-adherence-related risk of relapse. The Spanish market of oral antipsychotics has not changed in the past years. The objective of this study was to analyze the real use of oral antipsychotics in Spain and to interpret data from the clinical point of view.

METHODS : Analysis of oral antipsychotics prescription patterns in Spain by means of a representative sample of patients with schizophrenia from a Spanish Longitudinal IQVIA Patient Data base of two consecutive years (2016 and 2017) from 935 psychiatric sites.

RESULTS : The mean percentage of use for second-generation antipsychotics was 93.43% while first generation 6.57%. Among the demographical and epidemiological-calculated 207,313 patients under second-generation of oral antipsychotics, the actual pattern of use was olanzapine 33.65 %, quetiapine 16.70 %, aripiprazole 14.34%, paliperidone 13.68 %, risperidone 10.67 %, clozapine 4.84 %, amisulpride 3.10 %, ziprasidone 2.83 %.

CONCLUSIONS : A high and widespread use of second-generation oral antipsychotics is observed in the population diagnosed with schizophrenia in Spain. Prescription preferences (>80%) was predominantly using “pines” (olanzapine/quetiapine), “dones” (paliperidone/risperidone) or aripiprazole (the only dopaminergic partial agonist). This wide use could be due to the apparent need of different antipsychotics with different mechanisms of action able to adapt to patient’s characteristics. In an unchanged market for more than 10 years, it is also probable that new antipsychotics are still needed.