The advantage of using 3-week data to predict response to aripiprazole at week 6 in first-episode psychosis

Park, Jong-Il; Cho, Donghwan; Hahn, Sang‐Woo; Jeong, Bumseok; Kim, Jong-Hoon; Kim, Sung‐Wan; Koo, Min-Seong; Lee, Seung Hwan; Lee, Seung-Jae; Lee, Yo Han; Park, Jong-Ik; Rho, Seung Ho; Chung, Young‐Chul

doi:10.1097/yic.0000000000000005

Cited by 10 publications

(7 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent aripiprazole study involving first-episode psychosis revealed that the response at week 3 of aripiprazole treatment accurately predicts the later response (at week 6). 6 Nonetheless, no reports have described early prediction of a blonanserin response in patients with schizophrenia. In the present clinical trial, we enrolled patients with first-episode schizophrenia and patients with schizophrenia who did not take any antipsychotic medication for more than 4 weeks before enrollment in this study.…”

Section: Introductionmentioning

confidence: 99%

Early prediction of blonanserin response in Japanese patients with schizophrenia

Kishi¹,

Matsuda²,

Fujita³

et al. 2014

NDT

View full text Add to dashboard Cite

BackgroundBlonanserin is a second-generation antipsychotic used for the treatment of schizophrenia in Japan and Korea. The present study aimed to examine early prediction of blonanserin in patients with schizophrenia.MethodsAn 8-week, prospective, single-arm, flexible-dose clinical trial of blonanserin in patients with schizophrenia was conducted under real-world conditions. The inclusion criteria were antipsychotic naïve, and first-episode schizophrenia patients or schizophrenia patients with no consumption of any antipsychotic medication for more than 4 weeks before enrollment in this study. The positive predictive value, negative predictive value, sensitivity, specificity, and predictive power were calculated for the response status at week 4 to predict the subsequent response at week 8.ResultsThirty-seven patients were recruited (56.8% of them had first-episode schizophrenia), and 28 (75.7%) completed the trial. At week 8, blonanserin was associated with a significant improvement in the Positive and Negative Syndrome Scale (PANSS) total score (P<0.0001) and in positive (P<0.0001), negative (P<0.0001), and general subscale scores (P<0.0001). In terms of percentage improvement of PANSS total scores from baseline to week 8, 64.9% of patients showed a ≥20% reduction in the PANSS total score and 48.6% showed a ≥30% reduction. However, 8.1% of patients experienced at least one adverse event. Using the 20% reduction in the PANSS total score at week 4 as a definition of an early response, the negative predictive values for later responses (ie, reductions of ≥30 and ≥40 in the PANSS total scores) were 88.9% and 94.1%, respectively. The specificities were 80.0% and 51.6%, respectively.ConclusionOur results suggest that the blonanserin response at week 4 could predict the later response at week 8.

show abstract

Section: Introductionmentioning

confidence: 99%

Early prediction of blonanserin response in Japanese patients with schizophrenia

Kishi¹,

Matsuda²,

Fujita³

et al. 2014

NDT

View full text Add to dashboard Cite

show abstract

“…However, we found that while the prediction from the early response at 2 weeks was applicable to risperidone, it was not necessarily applicable to olanzapine . Subsequent studies confirmed these results, with two studies reporting that predictions of the later response could be made based on the response at 3 but not 2 weeks, while three studies reported being able to predict the later response at 4 weeks . One other study, however, reported that predictions could not be made before 6 weeks .…”

Section: How Does Practical Pharmacotherapy For Acute Schizophrenia Pmentioning

confidence: 69%

“…Out of the remaining 21, there were two articles that were not associated with response prediction from early responses, and one that was a duplicate of a previous article. After the discovery of one additional suitable article, a total of 19 articles were included in our review (Table ) …”

Section: How Does Practical Pharmacotherapy For Acute Schizophrenia Pmentioning

confidence: 99%

Practical pharmacotherapy for acute schizophrenia patients

Hatta

2015

Psychiatry Clin Neurosci

View full text Add to dashboard Cite

Well-organized clinical guidelines of pharmacotherapy for schizophrenia are not necessarily applicable to emergency and acute-phase situations. Thus, practical pharmacotherapy for acute schizophrenia patients should be based on data from real clinical practice and be independent of pharmaceutical companies. This study investigated the current guidelines being used to determine the initially preferred antipsychotics, durations required before an antipsychotic is viewed as being ineffective, and the strategies utilized for early non-responders that include switching, high dose, and augmentation. In patients who develop side-effects to the preferred antipsychotic drug, continued use may depend on the specific characteristics of the side-effects. For acute-phase patients, antipsychotics with high efficacy and effectiveness may be chosen based on meta-analysis findings for not only double-blinded but also raterblinded randomized controlled trials. Many previous studies have reported being able to make an early prediction at 2 weeks regarding the later response. These predictions were supported by the findings of a recent meta-analysis of 34 studies that examined 9975 participants. In early non-responders to the initial antipsychotic, the effectiveness of the switching strategy appears to depend on the initial antipsychotic administered and the antipsychotic the patient is subsequently switched to. Furthermore, the effectiveness of the strategy between switching and augmentation might also depend on the initial antipsychotic administered. The current findings might serve as the basis for the use of dosing above the licensed range versus continuing the use of conventional dosing in non-responders, provided there is close monitoring of the side-effects. Further research is required before any modifications of routine practices are undertaken regarding the direction of new potential treatments.

show abstract

“…Park et al determined that, when optimizing the dose of aripiprazole for schizophrenia, at least 3 weeks are needed to predict response or nonresponse at 6 weeks. 35 Given this evidence, clinicians need to increase the aripiprazole dose to an adequate therapeutic range for at least 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

Aripiprazole for the management of schizophrenia in the Japanese population: a systematic review and meta-analysis of randomized controlled trials

Kishi¹,

Matsuda²,

Matsunaga³

et al. 2015

NDT

View full text Add to dashboard Cite

BackgroundWe conducted a systematic review and meta-analysis of randomized controlled trials comparing aripiprazole with pooled antipsychotics in Japanese patients with schizophrenia.MethodsWe performed a literature search of data published in PubMed®, the Cochrane Library database, the Japan Medical Abstracts Society, and PsycINFO® up to January 5, 2014. The odds ratio (OR), number-needed-to-harm (NNH), and standardized mean difference (SMD) based on a random effects model were calculated.ResultsWe identified five relevant studies (seven comparisons, n=684; one comparison each for haloperidol [n=243], mosapramine [n=238], olanzapine [n=39], quetiapine [n=42], perospirone [n=100], and two comparisons for risperidone [n=66]). There were no significant differences in the Positive and Negative Syndrome Scale (PANSS) total, negative, and general scores (SMD=0.10, SMD=−0.09, SMD=0.10, respectively); discontinuation rate associated with all causes (OR=1.35); or side effects (OR=1.03) between aripiprazole and the pooled antipsychotics. Aripiprazole was inferior to the pooled antipsychotics in PANSS positive subscale scores (SMD=0.17) and discontinuation because of inefficacy (OR=2.21, NNH=11). However, aripiprazole had fewer side effects compared with the pooled antipsychotics (OR=0.21, NNH=20 for one or more side effects), including fatigue (OR=0.22, NNH=8), hyperprolactinemia (OR=0.00, NNH=1), extrapyramidal symptoms (OR=0.46, NNH=6), and weight gain (OR=0.36, NNH=7). Moreover, aripiprazole was associated with lower total cholesterol (SMD=−0.20) and triglyceride (SMD=−0.17) levels and body weight (SMD=−0.20) compared with the pooled antipsychotics.ConclusionAlthough the discontinuation rate associated with inefficacy was higher with aripiprazole than with the pooled antipsychotics, aripiprazole was associated with a lower risk of hyperprolactinemia and metabolic and extrapyramidal symptoms compared with the pooled antipsychotics.

show abstract

The advantage of using 3-week data to predict response to aripiprazole at week 6 in first-episode psychosis

Cited by 10 publications

References 38 publications

Early prediction of blonanserin response in Japanese patients with schizophrenia

Early prediction of blonanserin response in Japanese patients with schizophrenia

Practical pharmacotherapy for acute schizophrenia patients

Aripiprazole for the management of schizophrenia in the Japanese population: a systematic review and meta-analysis of randomized controlled trials

Contact Info

Product

Resources

About