Japanese Society of Neuropsychopharmacology: “Guideline for Pharmacological Therapy of Schizophrenia”

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doi:10.1002/npr2.12193

Cited by 62 publications

(22 citation statements)

References 512 publications

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“…Schizophrenia is a chronic and complex disease with a prevalence of approximately 0.5%–1.0% ( Simeone et al, 2015 ). Many guidelines recommend antipsychotic monotherapy as a first-line treatment for schizophrenia ( Galletly et al, 2016 ; Remington et al, 2017 ; Barnes et al, 2020 ; Keepers et al, 2020 ; Japanese Society of Neuropsychopharmacology, 2021 ). Antipsychotics are effective in improving symptoms of schizophrenia; however, approximately 30% of patients with schizophrenia do not respond to antipsychotics and develop treatment-resistant schizophrenia (TRS) ( Kane et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

“…Clozapine is the only licensed antipsychotic for TRS, and clozapine monotherapy is the recommended treatment for TRS in most guidelines ( Galletly et al, 2016 ; Remington et al, 2017 ; Barnes et al, 2020 ; Keepers et al, 2020 ; Japanese Society of Neuropsychopharmacology, 2021 ). Compared with other antipsychotics, clozapine has significant efficacy for overall symptoms, positive symptoms, and negative symptoms in the short term and significant efficacy for positive symptoms in the long term ( Siskind et al, 2016 ); however, clozapine can cause many adverse effects, such as hypersalivation, tachycardia, constipation, glucose intolerance, weight gain, seizure, myocarditis, and pneumonia ( Barnes et al, 2020 ; Japanese Society of Neuropsychopharmacology, 2021 ; Leon et al, 2022 ). In particular, neutropenia, including agranulocytosis, is a serious adverse effect of clozapine that can cause death ( Matsui et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…Antipsychotic polypharmacy is sometimes used in daily practice, such as in patients with insufficient improvement on antipsychotic monotherapy. Antipsychotic polypharmacy is associated with an increased risk of many adverse effects, such as extrapyramidal symptoms (EPSs) and hyperprolactinemia ( Barnes et al, 2020 ; Japanese Society of Neuropsychopharmacology, 2021 ). Because of these adverse effects, antipsychotic polypharmacy is not recommended in guidelines ( Galletly et al, 2016 ; Remington et al, 2017 ; Barnes et al, 2020 ; Keepers et al, 2020 ; Japanese Society of Neuropsychopharmacology, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Ochi

Tagata

Hasegawa

et al. 2022

International Journal of Neuropsychopharmacology

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Background Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Although antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; p < 2.0 × 10 -16) and the ND-TRS without clozapine group (54.7%; p < 2.0 × 10 -16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; p = 1.1 × 10 -6) and the ND-TRS without clozapine group (17.0%; p = 5.9 × 10 -6). Conclusions Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Ochi

Tagata

Hasegawa

et al. 2022

International Journal of Neuropsychopharmacology

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“…Schizophrenia is a chronic disorder with low rates of recovery, with only 13.5% of patients recovering in both the clinical and social domains [ 1 ]. Relapse, which hinders recovery [ 2 ], is common, with a first 5-year cumulative relapse rate of 81.9%, and a second cumulative 5-year relapse rate of 78.0% [ 3 ]. Continuous treatment is essential to prevent relapse in patients with schizophrenia [ 4 ], with one study showing that relapse risk increased by approximately fivefold when antipsychotic treatment was discontinued among patients who had achieved clinical stability [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…A network meta-analysis comparing 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia found that differences in terms of efficacy, including all-cause discontinuation, were small among second-generation antipsychotics (SGAs), while safety profiles (e.g., weight gain, QTc prolongation, sedation) differed greatly [ 8 ]. Due to the limited body of evidence to date, the treatment guidelines for schizophrenia in Japan do not recommend specific SGAs and state that medications should be chosen based on individual cases [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment Discontinuation Among Patients with Schizophrenia Treated with Brexpiprazole and Other Oral Atypical Antipsychotics in Japan: A Retrospective Observational Study

et al. 2022

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Introduction Treatment continuation is essential for relapse prevention in patients with schizophrenia. The aim of this exploratory study was to compare the time to treatment discontinuation between patients with schizophrenia prescribed brexpiprazole (BRX group) and those prescribed other atypical antipsychotics (OAA group) in clinical settings in Japan using health insurance claims data. Methods De-identified data of working individuals with schizophrenia aged < 75 years and their dependents were assessed from April 2017 to May 2020 using a nationwide claims database. Cox proportional hazards models, adjusted for baseline patient variables, were used to compare the time to treatment discontinuation (primary outcome) for 180 days between BRX and OAA groups and to estimate the hazard ratio (HR) with 95% confidence interval (CI). The cumulative treatment continuation rates at 180 days were also estimated. Sensitivity and subgroup analyses were conducted for the primary outcome. Results The analysis included 978 and 4898 patients in the BRX and OAA groups, respectively. Patients in the BRX group were significantly less likely to discontinue treatment than those in the OAA group (HR 0.86, 95% CI 0.78–0.95; p = 0.0024). The cumulative treatment continuation rates were higher in the BRX group (45.9%, 95% CI 42.5–49.2]) than in the OAA group (39.5%, 95% CI 38.1–41.0; log-rank test, p < 0.0001). Based on patients matched by propensity score, the BRX group was significantly less likely to discontinue treatment than the OAA group (log-rank test, p = 0.0466). Similar results were obtained in sensitivity and subgroup analyses. Conclusion This real-world study showed that patients in the BRX group were less likely to discontinue treatments than those in the OAA group. These findings suggest that BRX may contribute to treatment continuation among patients with schizophrenia. Trial Registration University hospital Medical Information Network (UMIN) Clinical Trials Registry: UMIN000044682. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02252-9.

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Antipsychotic dose reduction compared to dose continuation for people with schizophrenia

Rodolico

Siafis

Bighelli

et al. 2022

Cochrane Database of Systematic Reviews

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Background Antipsychotic drugs are the mainstay treatment for schizophrenia, yet they are associated with diverse and potentially dose‐related side effects which can reduce quality of life. For this reason, the lowest possible doses of antipsychotics are generally recommended, but higher doses are often used in clinical practice. It is still unclear if and how antipsychotic doses could be reduced safely in order to minimise the adverse‐effect burden without increasing the risk of relapse. Objectives To assess the efficacy and safety of reducing antipsychotic dose compared to continuing the current dose for people with schizophrenia. Search methods We conducted a systematic search on 10 February 2021 at the Cochrane Schizophrenia Group's Study‐Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, ISRCTN, and WHO ICTRP. We also inspected the reference lists of included studies and previous reviews. Selection criteria We included randomised controlled trials (RCTs) comparing any dose reduction against continuation in people with schizophrenia or related disorders who were stabilised on their current antipsychotic treatment. Data collection and analysis At least two review authors independently screened relevant records for inclusion, extracted data from eligible studies, and assessed the risk of bias using RoB 2. We contacted study authors for missing data and additional information. Our primary outcomes were clinically important change in quality of life, rehospitalisations and dropouts due to adverse effects; key secondary outcomes were clinically important change in functioning, relapse, dropouts for any reason, and at least one adverse effect. We also examined scales measuring symptoms, quality of life, and functioning as well as a comprehensive list of specific adverse effects. We pooled outcomes at the endpoint preferably closest to one year. We evaluated the certainty of the evidence using the GRADE approach. Main results We included 25 RCTs, of which 22 studies provided data with 2635 participants (average age 38.4 years old). The median study sample size was 60 participants (ranging from 18 to 466 participants) and length was 37 weeks (ranging from 12 weeks to 2 years). There were variations in the dose reduction strategies in terms of speed of reduction (i.e. gradual in about half of the studies (within 2 to 16 weeks) and abrupt in the other half), and in terms of degree of reduction (i.e. median planned reduction of 66% of the dose up to complete withdrawal in three studies). We assessed risk of bias across outcomes predominantly as some concerns or high risk. No study reported data on the number of participants with a clinically important change in quality of life or functioning, and only eight studies reported continuous data on scales measuring quali...

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Japanese Society of Neuropsychopharmacology: “Guideline for Pharmacological Therapy of Schizophrenia”

Cited by 62 publications

References 512 publications

Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Treatment Discontinuation Among Patients with Schizophrenia Treated with Brexpiprazole and Other Oral Atypical Antipsychotics in Japan: A Retrospective Observational Study

Antipsychotic dose reduction compared to dose continuation for people with schizophrenia

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