Long-Term Efficacy and Tolerability of Clozapine Combined with Ziprasidone or Risperidone

Kuwilsky, A.; Krumm, Bertram; Englisch, Susanne; Dreßing, Harald; Zink, Mathias

doi:10.1055/s-0030-1254089

Cited by 20 publications

(15 citation statements)

References 41 publications

(50 reference statements)

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“…Moreover, Ziprasidone was associated with the withdrawal of concomitant antipsychotics in all the patients but two (see Table 2). These findings are promisingly in keeping with results from schizophrenia trials and small studies suggesting that ziprasidone may allow a dose reduction/discontinuation of coprescribed medications, decrease appetite, and even bring about a sizeable weight loss [57, 58, 69]. …”

Section: Discussionsupporting

confidence: 71%

“…The efficacy and safety of the combination ziprasidone- clozapine in patients with schizophrenia have been proved in previous studies [11, 37, 44, 57, 58]. The efficacy of ziprasidone as monotherapy or in combination with mood stabilizers in patients with bipolar I disorder has been previously reported [60, 61].…”

Section: Discussionmentioning

confidence: 97%

“…In the absence of other risk factors for QTc prolongation/cardiac arrhythmias, ziprasidone prescription does not demand electrocardiogram monitoring [70]. Nevertheless, it would be interesting to add information about QTc variations in next studies, as Kuwilsky et al (2010) have already recorded a statistically significant QTc elongation in schizophrenic patients treated with the clozapine-ziprasidone association [57]. …”

Section: Study Limitationsmentioning

confidence: 99%

“…The association of ziprasidone to an ongoing clozapine treatment has proven effective in severe psychotic patients bringing about improvements of negative/cognitive symptoms and of clozapine related side effects, with only a minor QTc interval prolongation [11, 37, 44, 57, 58]. …”

Section: Introductionmentioning

confidence: 99%

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Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine

et al. 2014

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Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 97%

Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine

et al. 2014

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“…Ek olarak klozapini ziprasidon ile güçlendirme yönteminin risperidon ile güçlendirmeyle karşılaştırıldığı iki çalışmada, her iki uygulamanın da klinik etkinlik üzerinde olumlu sonuçları olduğu saptanmış, fakat ilaçlara bağlı yan etki profilleri farklılık göstermiştir (Zink ve ark. 2009, Kuwilsky ve ark. 2010.…”

Section: Bulgular Klozapin Tedavisinin Antipsikotiklerle Güçlendirilmesiunclassified

Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine Treatment

Vayısoğlu¹,

Yağcıoğlu²

2014

Turkish Journal of Psychiatry

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ÖZETKlozapin tedavisi kullanan şizofreni hastalarının önemli bir oranı tedaviye kısmi yanıt vermektedir. Bu grup hastalarda klozapin tedavisine değişik psikotropların eklendiği güçlendirme yöntemleri ile ilgili bulgular çelişkilidir. Bu derlemede klozapin tedavisine dirençli şizofre-ni hastalarında güçlendirme ajanlarının etkinliği ve güvenliği ile ilgili yazın verileri gözden geçirilmiştir. Klozapini tedaviye dirençli şizofreni hastalarında güçlendirmek için kullanılan ek tedaviler antipsikotikler, antidepresanlar, duygudurum düzenleyicileri, diğer farmakolojik ajanlar (örneğin omega 3 yağ asitleri ve glutamaterjik tedaviler) ve elektrokonvulzif tedavi (EKT) olarak gruplanmıştır. Klozapinin tedaviye dirençli şizofreni hastalarında güçlendirilmesi ile ilgili en çok kontrollü çalışma-nın lamotrijin ve risperidon ile yapılmış olduğu görülmektedir. Ancak, meta analizler iki ajanın da klozapine eklenmesinin yararını desteklememektedir. Klozapinin amisülprid, aripiprazol, mirtazapin, omega 3 yağ asitleri ve EKT ile güçlendirilmesinin olumlu sonuç verdiğini destekleyen çalışmalar olsa da, delil/kanıt yeterli değildir ve ek araştırma-lara gereksinim vardır. Güncel çalışmalarda başlıca kısıtlılık, örneklem küçüklüğü, klozapine direnç tanımının sabit olmaması ve tanımlanmış sonlanım ölçütleri ile çalışma desenlerinin farklılık göstermesidir. Sonuç olarak, klozapin tedavisine dirençli şizofreni hastalarında tedavinin güç-lendirilmesi yöntemlerinin başarısı ile ilgili henüz yeterli kanıt yoktur.Anahtar Sözcükler: Şizofreni, klozapin, tedaviye direnç, güçlendirme tedavisi SUMMARY Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine TreatmentA significant proportion of patients with schizophrenia receiving clozapine remain with partial response. In this group of patients findings regarding addition of various psychotropics to ongoing clozapine treatment for augmentation are controversial. In this review, literature regarding the efficacy and safety of adjunctive agents in clozapine resistant schizophrenic patients is examined. Augmentation agents added to clozapine in treatment resistant schizophrenic patients consist of antipsychotics, antidepressants, mood stabilizers, other agents (eg. omega 3 fatty acids and glutamatergic agents) and electroconvulsive therapy (ECT) in this review. The number of controlled studies evaluating augmentation of clozapine in schizophrenia patients are highest for risperidone and lamotrigine add on treatments. However, the results of recent meta-analyses studies do not support any benefit of either agent as adjunct to clozapine treatment. Some evidence regarding the success of clozapine augmentation with amisulpride, aripiprazole, mirtazapine, omega 3 fatty acids and ECT have been obtained which needs further clinical investigation. Current findings from relevant clinical studies point that theses studies have limitations of small sample size, variable definitions of clozapine resistance, heterogenity of outcome measures and methodological designs and th...

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Clozapine combined with different antipsychotic drugs for treatment-resistant schizophrenia

Barber

Olotu

Corsi

et al. 2017

Cochrane Database of Systematic Reviews

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The reliability of results from this review is limited, evidence is of low or very low quality. Furthermore, due to the limited number of included studies, we were unable to undertake formal meta-analyses. As a consequence, any conclusions drawn from these findings are based on single, small-sized RCTs with high risk of type II error. Properly conducted and adequately powered RCTs are required. Future trialists should seek to measure patient-important outcomes such as quality of life, as well as clinical response and adverse effects.

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Long-Term Efficacy and Tolerability of Clozapine Combined with Ziprasidone or Risperidone

Abstract: The combinations of clozapine with ziprasidone or risperidone exhibit long-term efficacy, but the level of evidence is limited. Further head-to-head comparisons of atypical antipsychotics as add-on to clozapine are necessary.

Cited by 20 publications

References 41 publications

Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine

Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine

Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine Treatment

Clozapine combined with different antipsychotic drugs for treatment-resistant schizophrenia

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