Fast versus slow strategy of switching patients with schizophrenia to aripiprazole from other antipsychotics
Journal
Journal of Clinical Psychopharmacology
Journal Volume
35
Journal Issue
6
Pages
635-644
Date Issued
2015
Author(s)
Lo W.-M.
Chan H.-Y.
Lin C-.F.
Abstract
This study aimed to compare strategies differing in the speed of switching schizophrenic patients to aripiprazole from other antipsychotic agents, with dual administration for 2 weeks and then tapering off the current antipsychotic in fast (within 1 week) versus slow (within 4 weeks) strategies. This 8-week, open-label, randomized, parallel study assigned patients with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia or schizoaffective disorder to either the fast-switching (n = 38) or slow-switching (n = 41) group. Efficacy assessments at 5 time points included Positive and Negative Syndrome Scale and Clinical Global Impression scale. Safety assessments included extrapyramidal symptoms, metabolic profile, serum prolactin level, QTc interval, and adverse events. Drug concentrations and cytochrome P450 CYP2D6 and CYP3A4 genotypes were also measured. The fastand slow-switching groups were comparable in demographical and clinical features at baseline and dropout rate. In the intention-to-treat analysis using mixed-effects models, there were significant within-group decreases over time in the Positive and Negative Syndrome Scale total scores (P = 0.03) and its subscores except for positive subscores, whereas no betweengroup differences were found. A reduction in body weight (P = 0.01) and lower levels of total cholesterol (P = 0.03), triglycerides (P = 0.03), and prolactin (P = 0.01) were noted in both groups but no increase in extrapyramidal symptoms or prolongation of QTc. The blood concentrations of aripiprazole in all patients were in a therapeutic range at day 56, with CYP2D6?10 polymorphisms being associated with aripiprazole concentrations. In conclusion, there is no significant difference between the fast-and slow-switching strategy in terms of improvements in clinical symptoms and metabolic profile in this 8-week study. ? 2015 Wolters Kluwer Health, Inc. All rights reserved.
SDGs
Other Subjects
amisulpride; aripiprazole; chlorpromazine; cholesterol; cytochrome P450 2D6; cytochrome P450 3A4; flurazine; haloperidol; neuroleptic agent; olanzapine; prolactin; risperidone; sulpiride; triacylglycerol; unclassified drug; aripiprazole; neuroleptic agent; adult; Article; body weight; cholesterol blood level; Clinical Global Impression scale; comparative study; controlled study; demography; disease severity; drug blood level; drug efficacy; drug half life; drug safety; drug substitution; drug tolerability; drug withdrawal; DSM-IV; extrapyramidal symptom; female; hospitalization; human; intention to treat analysis; major clinical study; male; morning dosage; open study; parallel design; Positive and Negative Syndrome Scale; priority journal; prolactin blood level; QT prolongation; QTc interval; randomized controlled trial; schizoaffective psychosis; schizophrenia; side effect; side effect; treatment duration; triacylglycerol blood level; drug administration; genetics; middle aged; outcome assessment; Psychotic Disorders; schizophrenia; treatment outcome; Adult; Antipsychotic Agents; Aripiprazole; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Psychotic Disorders; Schizophrenia; Treatment Outcome
Type
journal article