© Georg Thieme Verlag KG Stuttgart · New York
Does Oral Antipsychotic Pre-Treatment Influence Outcome of a Switch to Long-Acting Injectable Risperidone in Patients with Schizophrenia?
03. Februar 2010 (online)
Introduction: The objective of this open-label study was to evaluate treatment benefits of risperidone long-acting injectable (RLAI) in patients with schizophrenia following direct transition from oral risperidone (RIS) compared with transition from other oral second generation antipsychotics.
Methods: Stable in- or outpatients (n=206) receiving RIS or OQAZ (olanzapine, quetiapine, amisulpride, ziprasidone) were transitioned to RLAI for 12 weeks. The primary outcome was the between-group treatment difference in change in PANSS total score from baseline to endpoint. Secondary outcomes included health-related quality-of-life and therapeutic alliance.
Results: Mean between-group difference in the change in PANSS total score from baseline to endpoint was −6.1 (CI: −17.6, 5.4), suggesting greater improvement in OQAZ than RIS patients. Due to the pre-specified non-inferiority margin of 5.1, it could not be concluded that OQAZ pre-treatment results in an at least non-inferior PANSS reduction versus RIS pre-treatment. Patient satisfaction with medication and change in quality-of-life subscores showed advantages for OQAZ patients.
Discussion: Compared to RIS pre-treatment, clinically stable patients with schizophrenia who are pre-treated with OQAZ might draw a stronger clinical benefit from direct transition to RLAI.
- 1 Chue P, Eerdekens M, Augustyns I. et al . Comparative efficacy and safety of long-acting risperidone and risperidone oral tablets. Eur Neuropsychopharmacol. 2005; 15 111-117
- 2 Ereshefsky L, Mascarenas CA. Comparison of the effects of different routes of antipsychotic administration on pharmacokinetics and pharmacodynamics. J Clin Psychiatry. 2003; 64 ((Suppl 16)) 18-23
- 3 Eerdekens M, Van Hove I, Remmerie B. et al . Pharmacokinetics and tolerability of long-acting risperidone in schizophrenia. Schizophrenia Res. 2004; 70 91-100
- 4 Fleischhacker WW, Eerdekens M, Karcher K. et al . Treatment of schizophrenia with long-acting injectable risperidone: a 12-month open-label trial of the first long-acting second-generation antipsychotic. J Clin Psychiatry. 2003; 64 1250-1257
- 5 Guy W. ECDEU Assessment manual for psychopharmacology. Revised. Rockville, Maryland, USA: US Department of Health, Education and Welfare 1976; 217-222
- 6 Harrison TS, Goa KL. Long-acting risperidone: a review of its use in schizophrenia. CNS Drugs. 2004; 18 113-132
- 7 Kane JM. Pharmacologic treatment of schizophrenia. Biol Psychiatry. 1999; 46 1396-1408
- 8 Kane JM, Aguglia E, Altamura AC. et al . Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy. Eur Neuropsychopharmacol. 1998; 8 55-66
- 9 Kane JM, Eerdekens M, Lindenmayer J-P. et al . Long acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. Am J Psychiatry. 2003; 160 1125-1132
- 10 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale for schizophrenia. Schizophrenia Bull. 1987; 13 261-276
- 11 Keith SJ, Kane JM. Partial compliance and patient consequences in schizophrenia: our patients can do better. J Clin Psychiatry. 2003; 64 1308-1315
- 12 Keks NA, Ingham M, Khan A. et al . Long-acting injectable risperidone vs. olanzapine tablets for schizophrenia or schizoaffective disorder. Randomised, controlled, open-label study. Br J Psychiatry. 2007; 191 131-139
- 13 Lieberman JA, Stroup TS, McEvoy JP. et al . Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New Engl J Med. 2005; 353 1209-1223
- 14 Lindenmayer JP, Eerdekens E, Berry SA. et al . Safety and efficacy of long-acting risperidone in schizophrenia: a 12-week, multicentre, open-label study in stable patients switched from typical and atypical oral antipsychotics. J Clin Psychiatry. 2004; 65 1084-1089
- 15 Marder SR. Overview of partial compliance. J Clin Psychiatry. 2003; 64 ((Suppl 16)) 3-9
- 16 Möller HJ, Llorca PM, Sacchetti E. et al . Efficacy and safety of direct transition to risperidone long-acting injectable in patients treated with various antipsychotic therapies. Intl Clin Psychopharmacol. 2005; 20 121-130
- 17 Naber D, Moritz S, Lambert M. et al . Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophrenia Res. 2001; 50 79-88
- 18 Nasrallah HA, Duchesne I, Mehnert A. et al . Health-related quality of life in patients with schizophrenia during treatment with long acting, injectable risperidone. J Clin Psychiatry. 2004; 65 531-535
- 19 Tandon R, Belmaker RH, Gattaz WF. et al . World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophr Res. 2008; 100 20-38
- 20 Valenstein M, Blow FC, Copeland LA. et al . Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophrenia Bull. 2004; 30 255-264
- 21 Walburn J, Gray R, Gournay K. et al . Systematic review of patient and nurse attitudes to depot antipsychotic medication. Br J Psychiatry. 2001; 179 300-307
- 22 Ware J, Snow K, Kosinski M. SF-36 Health survey manual and interpretation guide. Boston, Massachusetts. The Health Institute 1993
- 23 Weiden PJ, Kozma C, Grogg A. et al . Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiat Serv. 2004; 55 886-891
- 24 Weiden J, Zygmunt A. Medication noncompliance in Schizophrenia, Pt 1: assessment. J Pract Psychiatry Behav Health. 1997; 106-111
- 25 World Health Organisation . International Classification of Diseases. 10th Revision 1994;
PD Dr. Bernd Ibach
Psychiatrische Dienste Thurgau