Korean Medication Algorithm Project for Bipolar Disorder 2022: Comparisons with Other Treatment Guidelines

Abstract

The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) with other recently published guidelines for treating bipolar disorder. We reviewed a total of six recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2022 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy in a same degree for mania. However, the KMAP-BP 2022 recommended MS + AAP combination therapy for psychotic mania, mixed mania and psychotic depression as treatment of choice. Aripiprazole, quetiapine and olanzapine were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Some guideline suggested olanzapine is a second-line options during maintenance treatment, related to concern about long-term tolerability. Most guidelines advocated newer AAPs (asenapine, cariprazine, long-acting injectable risperidone, and aripiprazole once monthly) as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. KMAP-BP 2022 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2022, predominantly in the treatment of psychotic mania, mixed mania and psychotic depression.

Global perspectives on bipolar disorder treatment: in-depth comparative analysis of international guidelines for medication selection

“… 13 The NICE guidelines provided relatively simple recommendations without clear evidence intensity, whereas the RANZCP guidelines presented treatment stages as ‘action’, ‘choice’ and ‘alternative’, similar to other mood disorder guidelines and combining evidence-based and consensus-based recommendations. 8 …”

“…The preferred treatment medications were lithium, valproate, aripiprazole, olanzapine and quetiapine (Table 2). 1,8,24 Treatment strategy for rapid-cycling bipolar disorder. In patients with rapid-cycling bipolar disorder experiencing manic episodes, primary strategies included a combination of mood stabilisers and atypical antipsychotics, mood stabiliser monotherapy and atypical antipsychotic monotherapy.…”

“…In the second stage, whereas NICE 2014 suggests transitioning to alternative antipsychotics or adding lithium or valproate, BAP 2016 recommends aripiprazole, carbamazepine, lithium and a combination of mood stabilisers with atypical antipsychotics (Table 4). 2,8,9 Treatment strategy for depressive episodes. In the first stage, the use of quetiapine, olanzapine and lurasidone as monotherapy was initially recommended by BAP 2016.…”

“…These recommendations have not been incorporated into KMAP-BP 2022. 8,12 The uniqueness of paliperidone is further underscored by being considered a first-line therapeutic agent solely in CINP-BD-2017, with CANMAT 2018 and RANZCP 2020 suggesting its use at a later stage. Paliperidone's limited approval only for schizophrenia treatment in Korea also contributes to its distinct status.…”

“…This evidence-based approach has had a pivotal role in the formulation of clinical practice guidelines and treatment algorithms for bipolar disorder. 8 However, the generation of scientific evidence and recommended treatments can vary depending on factors such as research infrastructure, health insurance policies, economic conditions and cultural distinctions in the country where the guidelines are established. 1 This study aimed to delve into and compare several international guidelines for treating bipolar disorder, updated after 2014, including those from the UK, Canada, Australia/New Zealand, South Korea and the International College of Neuropsychopharmacology (CINP), to discern the factors contributing to the observed differences among them.…”