Amisulpride, aripiprazole, and olanzapine in patients with schizophrenia-spectrum disorders (BeSt InTro): a pragmatic, rater-blind, semi-randomised trial

Johnsen, Erik; Kroken, Rune A.; Løberg, Else‐Marie; Rettenbacher, Maria A.; Joa, Inge; Larsen, Tor Ketil; Reitan, Solveig Klæbo; Walla, Berit; Alisauskiene, Renata; Anda, Liss; Bartz‐Johannessen, Christoffer; Berle, Jan Øystein; Bjarke, Jill; Fathian, Farivar; Hugdahl, Kenneth; Kjelby, Eirik; Sinkeviciute, Igne; Skrede, Sverre; Stabell, Lena Antonsen; Steen, Vidar M.; Fleischhacker, W. Wolfgang

doi:10.1016/s2215-0366(20)30341-2

Cited by 39 publications

(42 citation statements)

References 23 publications

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“…And the big advantage of pragmatic trials is they can often tell us something important about a treatment that isn't evident in controlled trials, either positive or negative. As Johnsen et al 2 note, the reductions in symptoms seen in this study were greater than those typically seen in controlled antipsychotic drug trials but were similar to those of other pragmatic trials. And again, the differences between treatments in this study were eye‐catching.…”

supporting

confidence: 83%

“…It prolongs the electrocardiographic QT interval a bit more than 40 mg of citalopram 4 . And in case you're wondering, our non‐North American psychopharmacologist colleagues probably wouldn't be quite as surprised by the Johnsen et al 2 findings as we might be — meta‐analyses of controlled trials tend to rank amisulpride somewhere between clozapine and olanzapine in terms of efficacy 3 …”

mentioning

confidence: 97%

“…The study, published by Johnsen and colleagues in Lancet Psychiatry , 2 describes a pragmatic trial of 144 patients with schizophrenia spectrum disorders and active psychotic symptoms who were randomized to treatment with amisulpride, aripiprazole, or olanzapine at one of four participating European academic medical centers. Patients were then followed for one year, during which time they were systematically assessed eight times.…”

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confidence: 99%

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Treating schizophrenia, part 2: What we can (almost) do now

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2021

Psychopharmacology Update

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In my last commentary, for the January 2021 issue, I took a look at the American Psychiatric Association's new practice guideline for the treatment of schizophrenia and suggested that even the “truisms” contained in that committee‐generated pronouncement merited consideration by busy practicing clinicians. The bottom line of my assessment was that we should try to maximize, as best we can, the impact of what we currently know (or think we know) in the care of our patients. I guess that notion of doing the most we can with the tools currently available has stuck with me, because one of the papers we cover in this month's Update on page 1 seems to have tapped into that same motif.

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confidence: 97%

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confidence: 99%

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Treating schizophrenia, part 2: What we can (almost) do now

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2021

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“…Further details can be found in the previous publication of the primary outcome. 16 The data presented here represent secondary outcomes in the BeSt InTro trial.…”

Section: Methodsmentioning

confidence: 99%

Differential Effectiveness of Atypical Antipsychotics on Hallucinations

Sinkeviciute

Hugdahl

Bartz‐Johannessen

et al. 2021

Journal of Clinical Psychopharmacology

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“…However, expert consensus only has a much lower level of evidence in comparison with DBRCTs and meta-analyses [24]. In the most recent headto-head RCT of 144 patients with schizophrenia-spectrum disorders, amisulpride was more efficacious than aripiprazole or olanzapine for reducing symptom severity [25]. Moreover, aripiprazole ranks low in the network meta-analysis of 32 antipsychotic drugs [19].…”

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confidence: 99%

Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus

et al. 2021

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Introduction Conventional treatment guidelines of schizophrenia do not necessarily provide solutions on clinically important issues. Methods A total of 141 certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology evaluated treatment options regarding 19 clinically relevant situations in the treatment of schizophrenia with a 9-point scale (1=“disagree” and 9=“agree”). Results First-line antipsychotics varied depending on predominant symptoms: risperidone (mean±standard deviation score, 7.9±1.4), olanzapine (7.5±1.6), and aripiprazole (6.9±1.9) were more likely selected for positive symptoms; aripiprazole (7.6±1.6) for negative symptoms; aripiprazole (7.3±1.9), olanzapine (7.2±1.9), and quetiapine (6.9±1.9) for depression and anxiety; and olanzapine (7.9±1.5) and risperidone (7.5±1.5) for excitement and aggression. While only aripiprazole was categorized as a first-line treatment for relapse prevention (7.6±1.0) in patients without noticeable symptoms, aripiprazole (8.0±1.6) and brexpiprazole (6.9±2.3) were categorized as such for social integration. First-line treatments in patients who are vulnerable to extrapyramidal symptoms include quetiapine (7.5±2.0) and aripiprazole (6.9±2.1). Discussion These clinical recommendations represent the expert consensus on the use of a particular antipsychotic medication for a particular situation, filling a current gap in the literature.

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Amisulpride, aripiprazole, and olanzapine in patients with schizophrenia-spectrum disorders (BeSt InTro): a pragmatic, rater-blind, semi-randomised trial

Cited by 39 publications

References 23 publications

Treating schizophrenia, part 2: What we can (almost) do now

Treating schizophrenia, part 2: What we can (almost) do now

Differential Effectiveness of Atypical Antipsychotics on Hallucinations

Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus

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