Efficacy, acceptability and tolerability of 8 atypical antipsychotics in Chinese patients with acute schizophrenia: A network meta-analysis

Bai, Zhihua; Wang, Guoqiang; Cai, Shangli; Ding, Xindi; Liu, Weiwei; Huang, Depei; Shen, Weidi; Zhang, Juncheng; Chen, Kui; Yang, Yuqing; Zhang, Lili; Zhao, Xiaochen; Ouyang, Qiong; Zhao, Jingping; Lu, Huafei; Hao, Wei

doi:10.1016/j.schres.2017.01.002

Cited by 28 publications

(18 citation statements)

References 20 publications

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“…There was no statistically significant difference in the incidence of EPS between other atypical antipsychotics (such as risperidone, ziprasidone, and so on) and typical antipsychotic drugs with low D2 receptor antagonism. The outcomes of study in Chinese populations also indicate that those who are taking high D2 receptor antagonistic effect atypical antipsychotic risperidone induce more EPS than those with low and moderate D2 receptor antagonistic effect 20 21. In summary, the D2 receptor antagonism effect of antipsychotic drugs may be related to the occurrence of EPS, and the impact of monotherapy or polytherapy of antipsychotics and classification of atypical or typical antipsychotics on incidence of EPS needs to be verified by larger sample trials.…”

Section: Discussionmentioning

confidence: 94%

Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia

Weng

Yan

et al. 2019

Gen Psych

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BackgroundExtrapyramidal symptoms (EPS) are one of the most common and neglected side effects during the treatment of schizophrenia. The risk factors of EPS in Chinese patients with schizophrenia and its relationship with psychiatric symptoms and mood symptoms of schizophrenia remain unknown.AimsThe main objective of this study is to explore the risk factors of EPS caused by antipsychotics and the relationship between EPS and psychotic symptoms and mood symptoms of schizophrenia.MethodThis study included 679 patients with schizophrenia who have met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Patients were divided into the EPS group and the non-EPS group according to the scale rating criteria and whether the anticholinergics have been used. The differences between demographic data and characters of drug intake were compared between the two groups, and the risk factors of EPS were selected between those factors. Correlation analysis was performed on the severity of schizophrenia (Positive and Negative Symptoms Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) score) and EPS scale (Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS) score) in 679 patients. The differences between the PANSS subscale score and the CDSS score between the EPS group and the non-EPS group were compared.ResultCompared with the non-EPS group, the EPS group patients are older, and they have a longer duration since first prescribed antipsychotics. The EPS group patients have higher frequency of atypical antipsychotics polytherapy and typical and atypical antipsychotics polytherapy or combined treatments with mood stabilisers. Logistic regression analysis shows that antipsychotics with high D2 receptor antagonistic effect and illness duration are the risk factors of EPS. The SAS score was significantly correlated with PANSS negative score, PANSS general psychopathological score and PANSS total score. The BARS scale score was significantly correlated with PANSS positive score, PANSS general psychopathological score, PANSS total score and CDSS total score. The AIMS scale score was significantly correlated with PANSS negative score. Compared with the non-EPS group, the EPS group patients have significantly higher PANSS negative score, PANSS general psychopathological score, PANSS total score and CDSS total score.ConclusionAntipsychotic drugs with high D2 receptor antagonism and disease duration are risk factors of EPS in Chinese patients with schizophrenia. The severity of various types of EPS is significantly correlated with the psychiatric and mood symptoms of schizophrenia, and psychiatric symptoms and mood symptoms were significantly more severe in the EPS group. The occurrence of EPS is associated with poor treatment outcome of schizophrenia.

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Section: Discussionmentioning

confidence: 94%

Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia

Weng

Yan

et al. 2019

Gen Psych

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“…In addition, it undergoes limited hepatic metabolism, thereby reducing the risks of hepatic drug–drug and drug–disease interactions 16. A recent network meta-analysis, comparing the efficacy, acceptability and tolerability of 8 atypical antipsychotics in Chinese patients with acute schizophrenia, demonstrated paliperidone ER to be in a position of superior efficacy with lower discontinuation risk 20. Another systematic review summarizing the clinical evidence of the efficacy, effectiveness and safety of paliperidone in the Chinese population reported that paliperidone ER demonstrated superior improvement in the PSP scores and at least comparable efficacy with active comparators assessed 15.…”

Section: Discussionmentioning

confidence: 99%

Treatment satisfaction with paliperidone extended-release tablets: open-label study in schizophrenia patients dissatisfied with previous antipsychotic medication

Yang

Tan

et al. 2017

NDT

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ObjectiveThe aim of this study was to evaluate the changes in treatment satisfaction after switching to paliperidone extended-release (ER) in Chinese schizophrenia patients dissatisfied with their previous antipsychotic treatment.MethodsIn this 8-week, open-label, single-arm, multicenter, prospective study, 1,693 patients dissatisfied with previous antipsychotic medication were enrolled and switched to paliperidone ER tablets (3–12 mg/d) based on clinical judgment. The primary efficacy end point was change in Medication Satisfaction Questionnaire (MSQ) score from baseline to week 8. The secondary end points included percentage of patients with MSQ score ≥4, as well as changes in Clinical Global Improvement-Severity (CGI-S) and Personal and Social Performance (PSP) scores.ResultsMSQ scores increased significantly from baseline (mean [standard deviation {SD}]: 2.48 [0.55]) to week 8 (5.47 [0.89], P<0.0001; primary end point, full analysis set). The percentage of patients with MSQ score ≥4 was 95.9% at week 8, indicating that most of the patients were satisfied with their treatment. Significant (P<0.0001) improvements from baseline to week 8 were noted in CGI-S score (2.37 [1.20]) and PSP score (25.5 [15.0]). A total of 174 (10.28%) patients experienced adverse events (AEs). The most common (>10 patients) events were extrapyramidal disorder (n=84, 4.96%), poor quality sleep (n=18, 1.06%) and akathisia (n=13, 0.77%). The majority of AEs were mild to moderate in severity. No deaths occurred.ConclusionTreatment satisfaction improved after switching to paliperidone ER from the previous antipsychotic in Chinese patients with schizophrenia.

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“…The increase in TEAE instances (32.1%, 51.3% and 90.7%) and weight gain (7.8%, 28.6% and 42.0%) in the 3-, 6- and 18-month study could be attributed possibly to the increased duration of therapy 23,24. The EPS-related TEAEs were noted to have the highest occurrence among all TEAEs in the 3-, 6- and the current 18-month study 22,28. Of note, the prolactin-related TEAEs (11.6% vs 15.7%) and glucose-related TEAEs (0.6% vs 0.9%) were comparable between the 6- and current 18-month study 24.…”

Section: Discussionmentioning

confidence: 94%

“…Cultural and ethnic variations in patients with schizophrenia have been widely acknowledged and are known to influence epidemiology, diagnosis, symptom expression and treatment outcomes 25–27. Differences in acceptability to antipsychotics and variances in efficacy and tolerability profiles of antipsychotics among Chinese patients with schizophrenia have been corelated with pharmacodynamic and pharmacokinetic inconsistencies and are known to have clinically relevant implications on prescription patterns in China 28,29. In addition, the influence of traditional herbal medicine, a prevalent practice in China and social stigma associated with psychiatric conditions, could potentially influence the course and outcomes of antipsychotic treatments 26,30,31.…”

Section: Introductionmentioning

confidence: 99%

<p>Long-term efficacy and safety of paliperidone palmitate once-monthly in Chinese patients with recent-onset schizophrenia</p>

Zhuo²,

Feng

et al. 2019

NDT

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Background: The subgroup analysis of a primary study (NCT01051531) evaluated the effect of long-term paliperidone palmitate once-monthly (PP1M) therapy in Chinese patients with recent-onset schizophrenia responding unsatisfactorily to previous oral antipsychotics. Patients and methods: This 18-month, open-label study consisted of 3 phases – screening (7 days), treatment (18 months) and end-of-study/withdrawal visit. All enrolled patients (18–50 years) received PP1M: 150 mg eq. (day 1), 100 mg eq. (day 8) followed by a once-monthly flexible dose (50, 75, 100 or 150 mg eq.). Efficacy and safety were assessed. Results: Among the 118 enrolled Chinese patients, 68 completed the treatment (mean age: 25.6 years; male: 54.7%). A clinically meaningful change from baseline to day 548 was observed in Positive and Negative Syndrome scale (primary endpoint, mean [SD]: −15.3 [20.76]), Personal and Social Performance scale (15.9 [19.65]), Clinician Global Impression-schizophrenia score (−1.2 [1.54]) and Medication Satisfaction Questionnaire score (0.9 [1.73]). Commonly reported treatment-emergent adverse events (TEAEs) included insomnia (13.9%), injection-site pain (13.9%), upper respiratory tract infection (13.0%), restlessness (13.0%) and akathisia (13.0%). Serious TEAEs were reported in 9.3% patients with schizophrenia being most common (6.5%) and one death (suicide) was observed. Conclusion: Efficacy of PP1M corroborate findings from earlier studies and no new safety concerns emerged in this Chinese subgroup of patients with schizophrenia.

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Efficacy, acceptability and tolerability of 8 atypical antipsychotics in Chinese patients with acute schizophrenia: A network meta-analysis

Cited by 28 publications

References 20 publications

Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia

Study on risk factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia

Treatment satisfaction with paliperidone extended-release tablets: open-label study in schizophrenia patients dissatisfied with previous antipsychotic medication

<p>Long-term efficacy and safety of paliperidone palmitate once-monthly in Chinese patients with recent-onset schizophrenia</p>

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