Comparative Effectiveness of Blonanserin and Paliperidone in 93 In-patients with Acute- to Maintenance-phase Schizophrenia

Abstract

When initiating treatment for acute-phase schizophrenia, careful consideration needs to be given to which drug will be used in the subsequent maintenance phase. Since blonanserin (BNS) and paliperidone (PAL) are both first-line treatments for acute-phase schizophrenia, our study retrospectively investigated the treatment continuation rate, dose levels, use of concomitant medications, clinical effects, and adverse drug reactions in 93 acute-phase schizophrenia patients receiving either of the monotherapies (BNS: n=40, PAL: n=53) to assess the treatment benefit of these drugs in acute-to maintenance-phase schizophrenia. The efficacy endpoints included the clinical global impression of severity (CGI-S), the clinical global impression of improvement (CGI-I) and the global assessment on function (GAF) scores assessed at Weeks 4, 8, 12, 24, and 52 after treatment initiation. Patients requiring involuntary hospitalization accounted for 75% of the BNS group and 90% of the PAL group and mostly comprised patients who had good social function before onset but relapsed because of poor drug adherence and hence received no residual benefit from their earlier treatment, as well as patients who were experiencing their first episode of schizophrenia. There were differences between the treatment groups in gender, age, and duration of illness. Notably, the BNS group had a higher proportion of females than the PAL group. In both groups, the CGI-S and CGI-I responses were affected by treatment in a majority of the patients who continued treatment, and the GAF score at Week 52 recovered to levels comparable to the pre-onset level in patients continuing treatment. The treatment continuation rate in this study (assessed by the Kaplan-Meier method) was 85% in the BNS group and 77% in the PAL group at Week 8 and 60.9% in the BNS group and 50.9% in the PAL group at Week 52. After Week 24, the number of dropouts in the BNS group decreased while the PAL group still had dropouts due to hyperprolactinemia-related adverse drug reactions. Treatment of schizophrenia requires careful selection of drugs in the acute phase that will ensure a good long-term prognosis and good drug adherence in the maintenance phase, and from this perspective, the results of this study suggest that BNS and PAL could be first-line drugs for the entire duration of treatment, from the acute phase to the maintenance phase.

Comparison of long-term efficacy and safety of blonanserin treatment in individuals with first-episode and relapsed schizophrenia: a 3-year retrospective study

“…The pituitary gland, which secretes hormones including prolactin, exists outside the blood-brain barrier (BBB). With blonanserin treatment, the brain/pituitary (B/P) ratio, calculated from the D2 receptor occupancy in the temporal lobe and the pituitary gland, showed that the percentage of drug crossing the BBB was greater than that of other antipsychotics [49]. This feature of blonanserin suggests that it may have considerable ability to distribute to the brain with a therapeutic efficacy that does not cause hyperprolactinaemia and problematic endocrine effects.…”