Predictors of Early Worsening after Switch to Aripiprazole

Pae, Chi‐Un; Chiesa, Alberto; Mandelli, Laura; Patkar, Ashwin A.; Gibiino, Sara; Serretti, Alessandro

doi:10.2165/11533060-000000000-00000

Cited by 13 publications

(12 citation statements)

References 22 publications

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“…Previous studies have indicated that antipsychotic-treated patients with schizophrenia or schizoaffective disorder can be switched to ARIP or ZIP with minimal long-term risk of relapse or symptom worsening (Simpson et al, 2008; Newcomer et al, 2008). However, some patients do not tolerate a medication switch or may experience clinical worsening (Kim et al, 2007; Pae et al, 2010; Takeuchi et al, 2009). In a randomized 12-week study (Newcomer et al, 2008), 8% of the study sample withdrew due to lack of efficacy.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of switching antipsychotic drug treatment to aripiprazole or ziprasidone for improving metabolic profile and atherogenic dyslipidemia: a 12-month, prospective, open-label study

et al. 2012

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We studied the effects of switching antipsychotic drug-treated patients with schizophrenia or bipolar disorder who evidenced adverse metabolic side effects as indicated by a triglyceride/high-density lipoprotein ratio (TG/HDL) ≥ 3.5 to aripiprazole (ARIP; 5-30 mg/day, n = 24) or ziprasidone (ZIP; 40-160 mg/day, n = 28). Anthropometric and metabolic measures, psychopathology, quality of life and motor adverse effects were assessed over a 52-week period with evaluations at baseline, 6, 12, 26 and 52 weeks. There were statistically significant improvements in body weight, body mass index (BMI), TG, HDL and TG/HDL which did not differ between treatments. However, numerous secondary measures including weight and BMI, and the proportion of patients who lost ≥ 7% or who no longer met criteria for obesity, favored ZIP over ARIP. Decreases in total cholesterol and increases in HDL-cholesterol also favored ZIP. On the other hand, decreases in TG/HDL ratio and reduction in HgbA1c favored ARIP. There were no significant time or group × time interaction effects for most psychopathology measures; however, Global Assessment of Functioning Scores favored ARIP at 6 and 12 months. We conclude that switching patients with evidence of metabolic side effects to either ARIP or ZIP may be beneficial for some, but not all metabolic measures, with minimal risk of worsening of psychopathology and possibly some benefit in that regard as well.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of switching antipsychotic drug treatment to aripiprazole or ziprasidone for improving metabolic profile and atherogenic dyslipidemia: a 12-month, prospective, open-label study

et al. 2012

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“…But on the basis of early case reports, these authors noted that combining aripiprazole with a non-clozapine second-generation antipsychotic might possibly worsen psychosis. Of possible relevance here is a 12-week, randomized, controlled, open-label study [67] designed to identify predictors of worsening in the first 4 weeks after a switch to aripiprazole in people whose schizophrenic illnesses had shown only partial response to previous treatments. The results persuaded the investigators that illness of relatively mild severity may be susceptible to early worsening of symptoms when switched to aripiprazole.…”

Section: Clinical Evidencementioning

confidence: 99%

Antipsychotic Polypharmacy in Schizophrenia

2011

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Antipsychotic polypharmacy refers to the co-prescription of more than one antipsychotic drug for an individual patient. Surveys of prescribing in psychiatric services internationally have identified the relatively frequent and consistent use of combined antipsychotics, usually for people with established schizophrenia, with a prevalence of up to 50% in some clinical settings. A common reason for prescribing more than one antipsychotic is to gain a greater or more rapid therapeutic response than has been achieved with antipsychotic monotherapy. However, the evidence on the risks and benefits for such a strategy is equivocal, and not generally considered adequate to warrant a recommendation for its use in routine clinical practice in psychiatry. Combined antipsychotics are a major contributor to high-dose prescribing, associated with an increased adverse effect burden, and of limited value in helping to establish the optimum maintenance regimen for a patient. The relatively widespread use of antipsychotic polypharmacy identified in cross-sectional surveys reflects not only the addition of a second antipsychotic to boost therapeutic response, but also the use of as-required antipsychotic medication (mainly to treat disturbed behaviour), gradual cross-titration while switching from one antipsychotic to another, and augmentation of clozapine with a second antipsychotic where the illness has failed to respond adequately to an optimized trial of clozapine. This review addresses the clinical trial data and other evidence for each of these pharmacological approaches. Also reviewed are examples of systematic, practice-based interventions designed to reduce the prevalence of antipsychotic polypharmacy, most of which have met with only modest success. Guidelines generally agree that if combined antipsychotics are prescribed to treat refractory psychotic illness, this should be after other, evidence-based, pharmacological treatments such as clozapine have been exhausted. Further, their prescription for each patient should be in the context of an individual trial, with monitoring of the clinical response and adverse effects, and appropriate physical health monitoring.

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“…Indeed several ARI trials suggested that a switching method of concomitant ARI initiation and tapering off of the current medication could cause a relapse of psychosis ( Lin et al., 2009 ; Pae et al., 2009 ), although this result was not always confirmed in other trials ( Casey et al., 2003 ; Kim et al., 2009 ). In addition, Pae and colleagues noticed a possible association between psychotic relapse following switching to ARI and DSP ( Pae, 2009 ; Pae et al., 2010 ). We consider that ARI’s agonistic effects may yield excessive dopaminergic effects via the high DRD2 density in patients with DSP, leading to psychotic worsening and switching failure.…”

Section: Introductionmentioning

confidence: 99%

Dopamine supersensitivity psychosis and dopamine partial agonist: A retrospective survey of failure of switching to aripiprazole in schizophrenia

et al. 2015

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The administration of aripiprazole (ARI), a dopamine partial agonist, could provoke abrupt psychotic worsening in patients with schizophrenia. We explored the relationship between this psychotic worsening and dopamine supersensitivity psychosis (DSP), which is a clinically vulnerable state. We conducted a retrospective investigation for 264 patients whose treatment medication was switched to ARI from other antipsychotics. We divided the patients into the DSP(+) group with a history of DSP episode(s) (N = 70) and the DSP(–) group without such a history (N = 194), and then compared the clinical factors relevant to the success or failure of the switch to ARI between them. The results revealed that patients in the DSP(+) group experienced psychotic worsening following the switch to ARI with a significant higher rate compared to the DSP(–) group (23% vs. 8%, P < 0.01). Moreover, the dosages of the drugs before the ARI introduction in the patients experiencing the psychotic worsening in the DSP (-) group were higher than those in other patients of the group. Our findings suggest that patients who receive high dosages of antipsychotic drugs form overt or covert DSP and such state is highly associated with psychotic worsening following ARI treatment.

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Predictors of Early Worsening after Switch to Aripiprazole

Cited by 13 publications

References 22 publications

Comparative effectiveness of switching antipsychotic drug treatment to aripiprazole or ziprasidone for improving metabolic profile and atherogenic dyslipidemia: a 12-month, prospective, open-label study

Comparative effectiveness of switching antipsychotic drug treatment to aripiprazole or ziprasidone for improving metabolic profile and atherogenic dyslipidemia: a 12-month, prospective, open-label study

Antipsychotic Polypharmacy in Schizophrenia

Dopamine supersensitivity psychosis and dopamine partial agonist: A retrospective survey of failure of switching to aripiprazole in schizophrenia

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