Antimanic Response to Aripiprazole in Bipolar I Disorder Patients Is Independent of the Agitation Level at Baseline

Sachs, Gary S.; Gaulin, B. D.; Gutierrez-Esteinou, Rolando; McQuade, Robert D.; Pikalov, A.; Pultz, Joseph A.; Sanchez, Raymond; Marcus, Ronald N.; Crandall, David T.

doi:10.4088/jcp.v68n0908

Cited by 19 publications

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“…Results from this study confirm findings from previous studies that have shown that aripiprazole is effective at rapidly controlling the symptoms of acute mania, 6,7 including agitation, 20 and adds to evidence supporting the use of aripiprazole monotherapy as maintenance of effect treatment beyond the acute phase. 21,22 In previous studies, aripiprazole was started at 30 mg/day, 6,7 whereas this study demonstrated the efficacy of aripiprazole with a treatment regimen starting at 15 mg/day.…”

Section: Discussionsupporting

confidence: 86%

Aripiprazole monotherapy in acute mania: 12-week randomised placebo- and haloperidol-controlled study

et al. 2009

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BackgroundWell-tolerated and effective therapies for bipolar mania are required.AimsTo evaluate the efficacy and tolerability of aripiprazole as acute and maintenance of effect therapy in patients with bipolar I disorder experiencing manic or mixed episodes.MethodPatients were randomised to double-blind aripiprazole (15 or 30 mg/day; n=167) placebo (n=153) or haloperidol (5–15 mg/day, n=165) for 3 weeks (trial registration NCT00097266). Aripiprazole- and haloperidol-treated patients remained on masked treatment for 9 additional weeks.ResultsMean change in Young Mania Rating Scale Total score (primary end-point) at week 3 was significantly greater with aripiprazole (–12.0; P<0.05) and haloperidol (–12.8; P<0.01) than with placebo (–9.7). Improvements were maintained to week 12 for aripiprazole (–17.2) and haloperidol (–17.8). Aripiprazole was well tolerated. Extrapyramidal adverse events were more frequent with haloperidol than aripiprazole (53.3% v. 23.5%).ConclusionsClinical improvements with aripiprazole were sustained to week 12. Aripiprazole was generally well tolerated.

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Section: Discussionsupporting

confidence: 86%

Aripiprazole monotherapy in acute mania: 12-week randomised placebo- and haloperidol-controlled study

et al. 2009

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“…A post-hoc analysis of these two studies found that the antimanic response to aripiprazole was independent of baseline level of agitation, suggesting a specific antimanic effect 16. In a separate post-hoc analysis of pooled efficacy data from these two studies, Frye and colleagues examined individual manic symptoms measured by the 11-item YMRS to determine how individual symptom improvement relates to overall improvement in patients with bipolar I disorder with an acute manic or mixed episode 17.…”

Section: Efficacy Studies Of Aripiprazole For Bipolar Maniamentioning

confidence: 99%

Treatment and prevention of mania in bipolar I disorder: focus on aripiprazole

Muzina¹

2009

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Aripiprazole is a second-generation antipsychotic with a unique pharmacologic receptor profile that has efficacy in the treatment and prevention of mania in bipolar I disorder. This article reviews the evidence supporting treatment of adults with bipolar I disorder using aripiprazole as monotherapy or adjunctively during acute mania and its utility as an intramuscular agent for agitation in manic patients. Results from one of the longest bipolar maintenance trials which support aripiprazole as a prophylactic mood stabilizer, specifically against manic relapses, will be discussed as well as a post-hoc analysis that suggests efficacy for rapid cycling bipolar disorder. Safety and tolerability issues, patient-focused perspectives and aripiprazole’s place in therapy for bipolar mania will be covered.

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“…As reported in the 2005 guidelines, three studies have demonstrated the efficacy of aripiprazole monotherapy compared to placebo (30, 31) or haloperidol (32) in the treatment of acute mania. While no new data are available, several pooled analyses provide additional support for these placebo‐controlled trials (33, 34). Aripiprazole was effective in patients with more or less severe illness, mixed or manic episodes, with or without psychotic features, and with a history of rapid or non‐rapid cycling; in men and women; in younger and older patients; in those with more or less severe depressive symptoms (33); and in those with or without agitation (34).…”

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confidence: 99%

“…While no new data are available, several pooled analyses provide additional support for these placebo‐controlled trials (33, 34). Aripiprazole was effective in patients with more or less severe illness, mixed or manic episodes, with or without psychotic features, and with a history of rapid or non‐rapid cycling; in men and women; in younger and older patients; in those with more or less severe depressive symptoms (33); and in those with or without agitation (34). One RCT assessed the role of adjunctive aripiprazole (discussed below in combination therapy) (35).…”

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009

et al. 2009

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder.

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Antimanic Response to Aripiprazole in Bipolar I Disorder Patients Is Independent of the Agitation Level at Baseline

Cited by 19 publications

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Aripiprazole monotherapy in acute mania: 12-week randomised placebo- and haloperidol-controlled study

Aripiprazole monotherapy in acute mania: 12-week randomised placebo- and haloperidol-controlled study

Treatment and prevention of mania in bipolar I disorder: focus on aripiprazole

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009

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Antimanic Response to Aripiprazole in Bipolar I Disorder Patients Is Independent of the Agitation Level at Baseline

Cited by 19 publications

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Aripiprazole monotherapy in acute mania: 12-week randomised placebo- and haloperidol-controlled study

Aripiprazole monotherapy in acute mania: 12-week randomised placebo- and haloperidol-controlled study

Treatment and prevention of mania in bipolar&nbsp;I disorder: focus on aripiprazole

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009

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Treatment and prevention of mania in bipolar I disorder: focus on aripiprazole