Early prediction of clinical response in first episode schizophrenia (FES) patients receiving olanzapine

Subeesh, Viswam; Maheswari, Eswaran; Singh, Hemendra; Saraswathy, G.R.; Neha, R.; Chiranjeevi, P

doi:10.1080/13651501.2020.1757118

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…Maybe somewhat limited by the small sample size, previous studies rarely investigate the optimal cut-off value in different antipsychotic monotherapy group. A previous study enrolled 36 first-episode schizophrenia patients on olanzapine monotherapy and evaluated whether early response (defined as a reduction of 20, 25, and 30% in PANSS score at weeks 2, 3, and 4) could predict a reduction of 50% at week 8, which found 30% in PANSS score at week 4 (with AUC = 92%) can be taken for the prediction [ 30 ]. This finding is similar to that of other investigators who have observed a prediction of a reduction of 40% at week 8 by using a reduction of 30% in PANSS score at week 4 [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial

Long

Yang

et al. 2023

BMC Med

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Background It remains a challenge to predict the long-term response to antipsychotics in patients with schizophrenia who do not respond at an early stage. This study aimed to investigate the optimal predictive cut-off value for early non-response that would better predict later non-response to antipsychotics in patients with schizophrenia. Methods This multicenter, 8-week, open-label, randomized trial was conducted at 19 psychiatric centers throughout China. All enrolled participants were assigned to olanzapine, risperidone, amisulpride, or aripiprazole monotherapy for 8 weeks. The positive and negative syndrome scale (PANSS) was evaluated at baseline, week 2, week 4, and week 8. The main outcome was the prediction of nonresponse. Nonresponse is defined as a < 20% reduction in the total scores of PANSS from baseline to endpoint. Severity ratings of mild, moderate, and severe illness corresponded to baseline PANSS total scores of 58, 75, and 95, respectively. Results At week 2, a reduction of < 5% in the PANSS total score showed the highest total accuracy in the severe and mild schizophrenia patients (total accuracy, 75.0% and 80.8%, respectively), and patients who were treated with the risperidone and amisulpride groups (total accuracy, 82.4%, and 78.2%, respectively). A 10% decrease exhibited the best overall accuracy in the moderate schizophrenia patients (total accuracy, 84.0%), olanzapine (total accuracy, 79.2%), and aripiprazole group (total accuracy, 77.4%). At week 4, the best predictive cut-off value was < 20%, regardless of the antipsychotic or severity of illness (total accuracy ranging from 89.8 to 92.1%). Conclusions Symptom reduction at week 2 has acceptable discrimination in predicting later non-response to antipsychotics in schizophrenia, and a more accurate predictive cut-off value should be determined according to the medication regimen and baseline illness severity. The response to treatment during the next 2 weeks after week 2 could be further assessed to determine whether there is a need to change antipsychotic medication during the first four weeks. Trial registration This study was registered on Clinicaltrials.gov (NCT03451734).

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Section: Discussionmentioning

confidence: 99%

Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial

Long

Yang

et al. 2023

BMC Med

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Finding Early Improvement Threshold to Predict Response After 8 Weeks of Treatment Using Risperidone in First-Episode Psychosis

Subeesh¹,

Maheswari²,

Singh

et al. 2020

J Clin Psychopharmacol

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Purpose/Background The study aims to assess whether the early response can predict the outcome at the endpoint for the treatment of first-episode psychosis with risperidone and identify the relationship between initial symptom reduction and late response. Methods/Procedures A prospective observational study with 4 points follow-up (weeks 2, 3, 4, and 8) was conducted in 48 adult first-episode psychosis patients. Symptoms were quantified by the Positive and Negative Syndrome Scale (PANSS) score. The initial recommended dose was 2 mg of risperidone once daily before sleep. The PANSS score on day 1 (before initiation of drug therapy) was considered as the baseline score. Treatment responses were considered as a reduction of more than 20%, 25%, 30% and 50% from the baseline score on first, second, third, and final follow-up, respectively. Receiver operating characteristic curves were generated for predicting response at the endpoint. Findings/Results Thirty-one (65%) patients achieved more than 50% reduction (responders) in PANSS score. The mean total PANSS score of the study population after 8 weeks of therapy was found to be 49.77 (95% confidence interval, 46.10–53.43). The mean percentage reduction in PANSS score after 8 weeks of therapy was found to be 52.92% (95% confidence interval, 48.83–57.01). Week 2 response can be taken as the early response (area under the curve = 81.9, P < 0.001). However, the more accurate prediction was possible with week 4 response (area under the curve = 88.7%, P < 0.001). Implications/Conclusions Our study suggests that patients with an early response at week 2 are likely to achieve positive response after 8 weeks.

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Early prediction of clinical response in first episode schizophrenia (FES) patients receiving olanzapine

Cited by 2 publications

References 23 publications

Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial

Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial

Finding Early Improvement Threshold to Predict Response After 8 Weeks of Treatment Using Risperidone in First-Episode Psychosis

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