A multicentre, randomized, naturalistic, open-label study between aripiprazole and standard of care in the management of community-treated schizophrenic patients Schizophrenia Trial of Aripiprazole: (STAR) study

Kerwin, Robert; Millet, Bruno; Herman, Erik; Bánki, Csaba M.; Lublin, Henrik; Pans, Miranda; Hanssens, Linda; L’Italien, Gilbert; McQuade, Robert D.; Beuzen, J.N.

doi:10.1016/j.eurpsy.2007.03.002

Cited by 96 publications

(85 citation statements)

References 35 publications

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“…weeks of treatment (Kerwin et al, 2007), so we predict that the treatment response measured here is likely to be close to the optimal response. The lack of relationship with improvement in negative symptoms suggests that treatment of negative symptoms is more multifactorial than that of positive symptoms and may depend on occupancy of other systems and in other regions.…”

Section: Clinical Ratingsmentioning

confidence: 99%

Dose–Occupancy Study of Striatal and Extrastriatal Dopamine D2 Receptors by Aripiprazole in Schizophrenia with PET and [18F]Fallypride

Kegeles

Slifstein

Frankle

et al. 2008

Neuropsychopharmacol

124

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Positron emission tomography (PET) and the high affinity D 2/3 radiotracer [18 F]fallypride allow the assessment of D 2/3 receptor occupancy of antipsychotic drugs in striatal and extrastriatal brain regions. We measured regional occupancy attained across a range of clinical dosing by the partial D 2 agonist aripiprazole using these methods. Twenty-eight PET scans were acquired on the ECAT EXACT HR + camera in 19 patients with schizophrenia or schizoaffective disorder. Daily aripiprazole doses ranged from 2 to 40 mg, with a minimum of 10 days on steady dose. Mean regional occupancies, a model-independent estimate of aripiprazole effect on pituitary binding, and PANSS ratings changes were evaluated. Occupancy levels were high across regions of interest, ranging from 71.6 ± 5.5% at 2 mg/day to 96.8 ± 5.3% at 40 mg/day. Occupancy levels were higher in extrastriatal than striatal regions. Pituitary measures of aripiprazole effect correlated with doses and were unrelated to prolactin levels, which remained within the normal range under medication. PANSS positive (but not negative) symptom improvement correlated with striatal but not extrastriatal occupancies. These data show, for the first time, D 2 occupancy by aripiprazole in treated patients with schizophrenia in extrastriatal as well as striatal regions, with high occupancy for all doses. We discuss possible explanations for higher extrastriatal than striatal occupancy. Correlations of ratings of clinical improvement with regional occupancy suggest that aripiprazole, as do other antipsychotics, benefits positive symptoms of schizophrenia most directly through its modulation of striatal rather than cortical or other extrastriatal dopamine activity.

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Section: Clinical Ratingsmentioning

confidence: 99%

Dose–Occupancy Study of Striatal and Extrastriatal Dopamine D2 Receptors by Aripiprazole in Schizophrenia with PET and [18F]Fallypride

Kegeles

Slifstein

Frankle

et al. 2008

Neuropsychopharmacol

124

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“…74 Paliperidone (9-hydroxyl-risperidone) is the major metabolite of risperidone, and prolactin concentrations in patients receiving paliperidone are double than those of patients receiving risperidone 2 and 9-hydroxyl-risperidone itself is probably responsible for the prolactin elevation. 37 Aripiprazole is associated with a low rate of hyperprolactinaemia with the prevalence rates of 3 -5% in RCTs that increase to incidence rates of 17% in naturalistic studies 2,75 and in a six-week RCT evaluating aripiprazole and perphenazine hyperprolactinaemia was reported in 4.4% of the aripiprazole cohort and 57.7% of the perphenazine cohort. 76 In some patients aripiprazole may also have a prolactinlowering effect; however, this does not occur in every patient.…”

Section: Rates Of Hyperprolactinaemia With Individual Antipsychoticsmentioning

confidence: 99%

A review of hyperprolactinaemia and severe mental illness: Are there implications for clinical biochemistry?

Bushe

Bradley

Pendlebury³

2010

Ann Clin Biochem

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Hyperprolactinaemia is a common adverse event reported in association with treatments used in schizophrenia and bipolar disorder. Recent data are suggestive that hyperprolactinaemia may have a range of significant short-and long-term clinical consequences. The objective of this review is to examine the causes, frequency and clinical consequences of hyperprolactinaemia in the severely mentally ill (SMI) with a focus on patients taking antipsychotic medications. A Medline search was carried out to identify relevant publications. Reference lists from previous review articles were also examined to search for additional data. Hyperprolactinaemia may be one of the most common adverse events associated with some antipsychotic medications. Precise rates with individual drugs had however until recently been poorly categorized. The relationship between hyperprolactinaemia and adverse outcomes in the SMI population appears similar to that in the general population. Adverse outcomes (such as sexual dysfunction) can occur acutely and in the longer term (bone fractures and possibly breast cancer), but the precise link between degree and length of hyperprolactinaemia and adverse outcome remains to be established. In conclusion, hyperprolactinaemia is a common treatment-emergent adverse event of some antipsychotic medications and may have clinical consequences. Physicians must balance the benefits and risks of treatment when determining appropriate therapy for individual patients.

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“…Aripiprazole is a partial dopamine agonist, which produces a unique and robust pharmacology that are distinct from those of other antipsychotics (Shapiro et al, 2003). Although it is unknown what effects might be expected from this unique and robust pharmacology, a recent study (Kerwin et al, 2007) suggested that aripiprazole has advantages over other atypical antipsychotics in functional outcomes. There is increasing evidence that functional skills (Bowie et al, 2006) and social perception (Sergi et al, 2006) mediate relationships between cognition and functional outcomes in schizophrenia, which suggests that the two mediators can be reasonable targets of atypical antipsychotics for improving social functioning.…”

Section: Discussionmentioning

confidence: 97%

Improvement in social competence in patients with schizophrenia: a pilot study using a performance‐based measure using virtual reality

Park

et al. 2009

Human Psychopharmacology

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A multicentre, randomized, naturalistic, open-label study between aripiprazole and standard of care in the management of community-treated schizophrenic patients Schizophrenia Trial of Aripiprazole: (STAR) study

Abstract: Aripiprazole is an effective atypical antipsychotic for the treatment of schizophrenia, demonstrating better effectiveness than SOC agents used in this study in patients for whom a switch in antipsychotic medication was warranted.

Cited by 96 publications

References 35 publications

Dose–Occupancy Study of Striatal and Extrastriatal Dopamine D2 Receptors by Aripiprazole in Schizophrenia with PET and [18F]Fallypride

Dose–Occupancy Study of Striatal and Extrastriatal Dopamine D2 Receptors by Aripiprazole in Schizophrenia with PET and [18F]Fallypride

A review of hyperprolactinaemia and severe mental illness: Are there implications for clinical biochemistry?

Improvement in social competence in patients with schizophrenia: a pilot study using a performance‐based measure using virtual reality

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