Increasing Versus Maintaining the Dose of Olanzapine or Risperidone in Schizophrenia Patients Who Did Not Respond to a Modest Dosage

Sakurai, Hitoshi; Suzuki, Takefumi; Bies, Robert R.; Pollock, Bruce G.; Mimura, Masaru; Kapur, Shitij; Uchida, Hiroyuki

doi:10.4088/jcp.15m10490

Cited by 11 publications

(5 citation statements)

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“…During pharmacotherapy for patients with schizophrenia, it is recommended that antipsychotics should be increased to an adequate dose within the tolerable range when the observed treatment response is insufficient. [1][2][3][4] However, randomized controlled trials (RCTs) and systematic reviews 5,6 have revealed conflicting reports, with little known about the optimal antipsychotic dose during the acute phase of schizophrenia. 7,8 Based on a systemic review of clinical guidelines, dosage recommendations reportedly varied based on 15 guidelines that suggest an optimal daily dose range for patients after the first psychotic episode in their acute phase 8 .…”

Section: Introductionmentioning

confidence: 99%

Divergence of dose–response with asenapine: a cluster analysis of randomized, double-blind, and placebo control study

et al. 2021

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Background Differences in psychiatric background and dose–response to asenapine in patients with schizophrenia were examined based on efficacy and safety, using data obtained in a double-blind, placebo-controlled trial. Methods Patients with schizophrenia were classified into three clusters by a cluster analysis based on the Positive and Negative Symptom Scale (PANSS) subscores at baseline, using the data from a 6-week, double-blind, placebo-controlled trial. PANSS Marder factor scores were calculated for each cluster. The efficacy of 10 or 20 mg/day of asenapine on PANSS score was used as the primary endpoint, with the incidence of adverse events evaluated as the secondary endpoint. Results A total of 529 asenapine-treated patients were classified into 3 clusters: Cluster-P with the higher scores in positive symptoms, disorganized thoughts, and hostility/excitement, Cluster-N with higher scores in negative symptoms, and Cluster-L with overall lower scores. In Cluster-N and Cluster-L, both 10 and 20 mg/day groups showed significant improvement in PANSS scores, while only the 20 mg/day group showed a significant difference in Cluster-P. Cluster-N and Cluster-L had differences in the incidence of adverse events, but this was not seen in Cluster-P. Conclusions The efficacy and safety of asenapine 10 and 20 mg/day differed between the 3 clusters of patients. This suggests that background information regarding baseline psychiatric symptoms may affect the therapeutic response in patients with schizophrenia.

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Section: Introductionmentioning

confidence: 99%

Divergence of dose–response with asenapine: a cluster analysis of randomized, double-blind, and placebo control study

et al. 2021

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“…Once an antipsychotic is titrated to the lower end of the recommended dosing range, it becomes unclear how much additional benefit will come from increasing the dose further. In fact, a previous randomized controlled trial 16 in 2016 found that among 103 patients with schizophrenia who failed to respond to moderate doses of olanzapine or risperidone, increasing the dose further did not result in significant improvements in response rate. Additionally, the study completion rate was significantly higher in the continuation group compared to the dose increment group, demonstrating that patients who continued to have their dose increased were less likely to adhere to treatment.…”

Section: Discussionmentioning

confidence: 99%

Start low, go fast? Antipsychotic titration patterns at an inpatient psychiatric hospital

Vadiei

Chien

Enwereji

et al. 2020

Mental Health Clinician

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Introduction Antipsychotics are commonly used to treat psychotic symptoms and severe mental illnesses. Treatment guidelines recommend antipsychotics be titrated quickly to therapeutic effect in the acute setting but acknowledge that determining the optimal dose is complicated by a delay between treatment initiation and therapeutic response. The purpose of this study was to evaluate antipsychotic titration patterns in an inpatient psychiatric hospital. Methods This study is a retrospective chart review of adult patients admitted to a teaching hospital and initiated on an antipsychotic for treatment of psychosis between January and December 2018. Patients were excluded if they had substance-induced psychosis, delirium, were prescribed >1 antipsychotic, or had no antipsychotic dose changes. The primary outcome was the average titration rate of the newly initiated antipsychotic. Secondary outcomes included differences in titration rate between involuntary and voluntary admissions and other antipsychotic characteristics. Results Of 149 patients included, the majority had a primary diagnosis of schizophrenia. Antipsychotics were titrated on average every 2 days regardless of admission type. Eighteen percent of patients were titrated to guideline-recommended maximum doses, and it took, on average, 3 days for patients to reach their final dose during hospitalization. Average length of stay was 9 days, and 43.6% of patients were readmitted within 1 year. Discussion Antipsychotics are titrated rapidly in the inpatient setting despite a lack of evidence regarding the impact of titration rate on clinical outcomes. Further studies comparing slow versus rapid titration strategies are needed to elucidate the impact of this on patient outcomes.

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“…Psychopathology was assessed with the PANSS at baseline and weeks 1, 2, 4, and 6 in all studies. In this analysis, response was defined as a ≥ 25% reduction in the total PANSS score from baseline to endpoint as a 20–30% cutoff threshold has generally been employed in previous antipsychotic clinical trials .…”

Section: Methodsmentioning

confidence: 99%

Placebo effects in adult and adolescent patients with schizophrenia: combined analysis of nine RCTs

Kubo

Fleischhacker

Suzuki

et al. 2018

Acta Psychiatr Scand

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Increasing Versus Maintaining the Dose of Olanzapine or Risperidone in Schizophrenia Patients Who Did Not Respond to a Modest Dosage

Abstract: UMIN.ac.jp/ctr/index.htm identifier: UMIN000008667.

Cited by 11 publications

References 0 publications

Divergence of dose–response with asenapine: a cluster analysis of randomized, double-blind, and placebo control study

Divergence of dose–response with asenapine: a cluster analysis of randomized, double-blind, and placebo control study

Start low, go fast? Antipsychotic titration patterns at an inpatient psychiatric hospital

Placebo effects in adult and adolescent patients with schizophrenia: combined analysis of nine RCTs

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