Monotherapy vs. combination therapy for post mania maintenance treatment: A population based cohort study

Wingård, Louise; Brandt, Lena; Bodén, Robert; Kieler, Helle; Andersen, Morten; Reutfors, Johan

doi:10.1016/j.euroneuro.2019.04.003

Cited by 18 publications

(12 citation statements)

References 35 publications

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“…The pilot trial conducted by Solomon and colleagues was the only study showing a significant effect on the frequency of mood relapses of the drug combination versus lithium monotherapy (relative risk, RR = 0.12), although several shortcomings as the small sample size (<10 patients per arm) 16 . The other studies, 2 RCTs and 1 observational study, 12‐14 consistently suggest some advantages in terms of time to mood relapse or treatment failure in the combination treatment group (hazard ratio, HR, between 0.72 and 0.80), although these results did not reach statistical significance. The BALANCE study also shows a non‐significant delay in time to manic episodes with polypharmacy (HR = 0.66), although the same tendency does not apply to depressive episodes (HR = 1.06) 13…”

Section: Resultsmentioning

confidence: 99%

Polypharmacy as maintenance treatment in bipolar illness: A systematic review

Amerio

Russo

Miletto

et al. 2021

Acta Psychiatr Scand

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Objectives Polypharmacy is common in maintenance treatment of bipolar illness, but proof of greater efficacy compared to monotherapy is assumed rather than well known. We systematically reviewed the evidence from the literature to provide recommendations for clinical management and future research. Method A systematic review was conducted on the use of polypharmacy in bipolar prophylaxis. Relevant papers published in English through 31 December 2019 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. Results Twelve studies matched inclusion criteria, including 10 randomized controlled trials (RCTs). The best drug combination in prevention is represented by lithium + valproic acid which showed a significant effect on time to mood relapses (HR = 0.57) compared to valproic acid monotherapy, especially for manic episodes (HR = 0.51). The effect was significant in terms of time to new drug treatment (HR = 0.51) and time to hospitalization (HR = 0.57). A significant reduction in the frequency of mood relapses was also reported for lithium + valproic acid vs. lithium monotherapy (RR=0.12); however, the trial had a small sample size. Lamotrigine + valproic acid reported significant efficacy in prevention of depressive episodes compared to lamotrigine alone. Conclusions The literature to support a generally greater efficacy with polypharmacy in bipolar illness is scant and heterogeneous. Within that limited evidence base, the best drug combination in bipolar prevention is represented by lithium + valproic acid for manic, but not depressive episodes. Clinical practice should focus more on adequate monotherapy before considering polypharmacy.

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Section: Resultsmentioning

confidence: 99%

Polypharmacy as maintenance treatment in bipolar illness: A systematic review

Amerio

Russo

Miletto

et al. 2021

Acta Psychiatr Scand

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“…The remaining 6 studies reported by Kessing et al in their review come to more or less comparable conclusions using different examination criteria [18]. Only the Swedish study by Wingard et al [27,28] failed to demonstrate the superiority of lithium.…”

Section: Interpretation Compared To Similar Studiesmentioning

confidence: 95%

Bipolar Disorder and Outcomes of Monotherapy with Lithium, Valproate, Quetiapine, Olanzapine, Venlafaxine, and Citalopram

et al. 2021

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Introduction The aim of this study was to compare the outcomes of monotherapy in individuals with bipolar disorder who are prescribed lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in private psychiatric practices in Germany. Methods This retrospective study included bipolar disorder patients who had initially started on a monotherapy with lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in 93 private neuropsychiatric practices in Germany between January 2006 and December 2017. Treatment failure was defined as time to discontinuation of medication or addition of another mood stabilizer, antipsychotic, antidepressant, or benzodiazepine. Results A total of 4990 bipolar patients was examined for the period between 2006 and 2019. Initially, monotherapy with lithium (n=1.098), valproate (n=502), quetiapine (n=927), olanzapine (n=927), venlafaxine (n=574), or citalopram (n=962) was prescribed. Within 24 months, treatment failure had occurred in 76.3% (lithium), 85.1% (valproate), 84.6% (quetiapine), 85.2% (venlafaxine), 92.1% (olanzapine), and 86.6% (citalopram) of patients, respectively. The hazard ratio for treatment failure compared to lithium as reference was highest for olanzapine at 1.66 (1.46–1.88), followed by citalopram 1.27 (1.15–1.39), quetiapine 1.18 (1.07–1.29), valproate 1.18 (1.06–1.33), and venlafaxine 1.14 (1.02–1.27). Conclusions Our results underline the importance of lithium in the maintenance treatment of bipolar disorders.

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“…The main limitations for the use of the combined treatment are the problems of tolerability and the increased risk of adverse effects [11,36]. However, this does not always lead to discontinuation of the treatment, since the benefit perceived by the patient, in terms of symptomatic or syndromic remission, could prevail over the negative effects of the treatment [6]. This would explain the aforementioned increase in the use of combination therapies in real-world practice.…”

Section: Case Descriptionmentioning

confidence: 99%

“…The recurrent nature of bipolar disorder is the most determining factor in the long-term prognosis and therefore, implementing an effective maintenance treatment to prevent relapses is crucial [5]. Nonetheless, recurrence rates in BD remain high, with two-year relapse rates of 50% [6]. In women with BD, the postpartum is a particularly critical period.…”

Section: Introductionmentioning

confidence: 99%