Effectiveness of risperidone long-acting injection in first-episode schizophrenia: In naturalistic setting

Kim, Borah; Lee, Sanghyuk; Choi, Tai Kiu; Suh, Shin Young; Kim, Young Kook; Lee, EunHee; Yook, Ki Hwan

doi:10.1016/j.pnpbp.2008.03.012

Cited by 82 publications

(88 citation statements)

References 17 publications

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“…Our finding that brief periods of oral medication nonadherence led to a return of psychosis is consistent with the previous literature on first-episode schizophrenia (4)(5)(6)(7)28). The present study extended these findings to the early phases of schizophrenia by using welloperationalized definitions of nonadherence that quantified three levels of partial nonadherence.…”

Section: Discussionsupporting

confidence: 92%

Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Subotnik

Nuechterlein²,

Ventura³

et al. 2012

FOC

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Objective-This study examined the effect of medication nonadherence on the return of positive symptoms among recent-onset schizophrenia patients.Method-Three sets of operational criteria for medication nonadherence with differing levels of severity were compared for their ability to predict relapse. Explicit operational criteria are provided with the hope that they will be adopted by others. Psychotic symptoms were prospectively rated on a frequent basis, and systematic criteria were applied using a computer scoring program to identify periods of psychotic symptom return. In addition, a specialized statistical survival analysis method, optimal for examining risk periods and outcomes that can recur during the follow-up assessment, was used.Results-As hypothesized, medication nonadherence robustly predicted a return of psychotic symptoms during the early phase of schizophrenia (hazard ratios=3.7-28.5, depending on the severity of nonadherence). Conclusions-Even brief periods of partial nonadherence lead to greater risk of relapse thanwhat is commonly assumed. Patients in the early phase of schizophrenia should be cautioned about the possible consequences of partial or relatively brief periods of antipsychotic medication nonadherence.Nonadherence to antipsychotic medication is quite common among schizophrenia patients and is the greatest obstacle to recovery and relapse prevention. This issue is heightened among individuals with a recent onset of schizophrenia who are just beginning to come to terms with having a psychiatric disorder and have not been in treatment long enough to recognize the necessity of adhering to their medication regimen (1). Approximately 50% of patients discontinue antipsychotic medication or have significant nonadherence to their Address correspondence and reprint requests to Dr. Subotnik, University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, 300 UCLA Medical Plaza, Rm. 2240, Los Angeles, CA 90095-6968; ksubotnik@mednet.ucla.edu. HHS Public AccessAuthor manuscript Am J Psychiatry. Author manuscript; available in PMC 2016 October 19. Published in final edited form as: Am J Psychiatry. 2011 March ; 168(3): 286-292. doi:10.1176/appi.ajp.2010.09010087. Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript medication regimen within 1 year of beginning treatment, with rates rising to 75% within 2 years (2). Some evidence indicates that nonadherence is greater in the early course of the disorder (3). The clinical implications of nonadherence among first-episode patients are dramatic. Morken et al. (4) demonstrated an odds ratio of 10.3 for psychotic relapse among nonadherent first-episode patients. In another study of first-episode schizophrenia patients, those who discontinued their medication had an almost fivefold increase in the risk for a first and second relapse (5). Üçok et al. (6) demonstrated that first-episode schizophrenia patients who experienced a psychotic relapse h...

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Section: Discussionsupporting

confidence: 92%

Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Subotnik

Nuechterlein²,

Ventura³

et al. 2012

FOC

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“…Among prospective observational studies, adjusted RRs range from 0.30 (Kim et al, 28 oral risperidone vs longacting risperidone) to 0.89 (Olivares et al, 5 oral atypical vs long-acting risperidone). Risk ratios for retrospective observational studies range from 0.16 (Tiihonen et al, 8 oral haloperidol vs depot haloperidol) to 0.71 (Tavcar et al, 32 oral typical vs depot typical).…”

Section: Adjusting For Baseline Differences In Gender and Agementioning

confidence: 99%

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Kirson¹,

Weiden²,

Yermakov³

et al. 2013

J. Clin. Psychiatry

163

128

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Objective: Nonadherence is a major challenge in schizophrenia treatment. While long-acting (depot) antipsychotic medications are often recommended to address adherence problems, evidence on the comparative effectiveness of depot versus oral antipsychotics is inconsistent. We hypothesize that this inconsistency could be due to systematic differences in study design. This review evaluates the effect of study design on the comparative effectiveness of antipsychotic formulations. The optimal use of different antipsychotic formulations in a general clinical setting depends on better understanding of the underlying reasons for differences in effectiveness across research designs.Data Sources: A PubMed literature review targeted English-language studies (2000-2011) with information on relapse, hospitalization, or allcause discontinuation for depot and oral antipsychotic treatment arms in schizophrenia. The time frame was chosen to reflect research focused on the newer generation of antipsychotic agents. The search required at least 1 term from each of the following categories: (1) schizophrenia; (2) inject, injection, injectable, injectables, injected, depot, long-acting; and (3) iloperidone, fluphenazine, haloperidol, paliperidone, risperidone, olanzapine, asenapine, flupentixol, flupenthixol, lurasidone, clopenthixol, fluspirilene, zuclopentixol, zuclopenthixol. Study Selection: Thirteen relevant studies were identified by 2 independent reviewers; these studies included information on 19 depot-oral comparisons.Data Extraction: Age-and gender-adjusted risk ratios (RRs) (depot/ oral) were calculated for the identified endpoints and pooled by study design (randomized controlled trial [RCT], prospective observational, and retrospective observational). Meta-analysis with random effects was used to estimate the pooled RRs, by study design. Average conversion factors between study designs were calculated as the ratios of pooled RRs.Results: Meta-analysis of adjusted endpoints showed no apparent benefit of depot over oral formulations in RCTs, with an RR of 0.89 (P = .416). In contrast, there was a significant advantage for depot formulations in other study designs (prospective RR = 0.62 [P < .001]; retrospective RR = 0.56 [P < .001]). These imply conversion factors of 1.43 and 1.59 between RCTs and prospective and retrospective designs, respectively. Conclusions:The comparative effectiveness of antipsychotic formulations is sensitive to research design. Depot formulations displayed significant advantages in nonrandomized observational studies, whereas in RCTs no difference was observed. The estimated conversion factors may facilitate comparison across studies.

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“…5; Heres et al, 2006Heres et al, , 2011. Scientific data underlined that the use of LAI SGAs as early as the first psychotic episode offers many advantages in terms of efficacy and tolerance (Emsley et al, 2008a(Emsley et al, , 2008bKim et al, 2008). Improving adherence seems to be particularly important early on in the disease, with greater improvement in clinical outcomes in patients treated with risperidone LAI (RLAI) who were recently diagnosed with schizophrenia than in those with chronic schizophrenia (Olivares et al, 2009).…”

Section: Reasons For Nonuse Of Depot Medicationmentioning

confidence: 99%

Clinicians’ Attitudes Toward the Use of Long-Acting Injectable Antipsychotics

Samalin¹,

Charpeaud²,

Blanc³

et al. 2013

Journal of Nervous &Amp; Mental Disease

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Depot formulations are not widely used in everyday practice. This study aimed to assess psychiatrists' attitudes toward the use of long-acting injectable (LAI) antipsychotics in schizophrenia. We interviewed 113 French psychiatrists about the factors that influenced their prescription of LAI antipsychotics. Multidimensional and cluster analyses were used to detect correlations. The most important factor against the use of LAI antipsychotics is a sufficient estimated compliance with the oral formulation. For first-generation LAI, the main factor is the risk for extrapyramidal symptoms; and for secondgeneration LAI, it is the unavailability of the equivalent oral formulation. Four factors incite the psychiatrists to prescribe LAI. Two different clusters of patients can also be identified. Most factors influencing the clinicians' attitudes toward the use of LAI antipsychotics are shared in many countries. Conversely, some attitudes related to organizational aspects, particularly the relevance of health care costs, may vary from one country to another.Key Words: Antipsychotics, long-acting injectable, attitudes, schizophrenia (J Nerv Ment Dis 2013;201: 553Y559) A ccording to systematic reviews, between 40% and 60% of patients with schizophrenia are known to be partially or totally noncompliant to oral antipsychotic medication (Dolder et al., 2002;Valenstein et al., 2004). Poor adherence is associated with higher risk for relapse of schizophrenia and increased health care costs (Patel et al., 2008).However, depot formulations are not widely used in routine practice, with a prescription rate of generally lower than 30% in different countries (Barnes et al., 2009; Patel and David, 2011). However, the use of long-acting injectable (LAI) formulations varies between countries. The prescription rates are higher in France (23.5%;Fourrier et al., 2000) and in the United Kingdom (29%; Barnes et al., 2009) compared with other European countries and with Canada (6.3%; Williams et al., 2006) or the United States (17.6%; West et al., 2008).This discrepancy between countries can be considered to derive from the health care system and from the different attitudes displayed by psychiatrists.Perceived coercion or presumed risks for lower tolerance of depot forms have been identified as factors responsible for this low use (Heres et al., 2006; Patel and David, 2011). More generally, negative attitudes from practitioners toward these forms have been shown to account for part of the low prescription rates of depot antipsychotics (Hamann et al., 2010;Heres et al., 2006Heres et al., , 2008Heres et al., , 2011.The main goal of our study was to assess the attitudes of psychiatrists toward LAI antipsychotics in patients with schizophrenia to understand the reasons for using or not assigning depot treatment.We studied these attitudes in a sample of psychiatrists working in France using the same questionnaire that was used in a population of German psychiatrists (Heres et al., 2006(Heres et al., , 2008. Our results will be discus...

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Effectiveness of risperidone long-acting injection in first-episode schizophrenia: In naturalistic setting

Cited by 82 publications

References 17 publications

Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Clinicians’ Attitudes Toward the Use of Long-Acting Injectable Antipsychotics

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