Role of Long-Acting Injectable Second-Generation Antipsychotics in the Treatment of First-Episode Schizophrenia: A Clinical Perspective

Přikryl, Radovan; Kučerová, Hana Přikrylová; Vrzalová, Michaela; Češková, Eva

doi:10.1155/2012/764769

Cited by 21 publications

(19 citation statements)

References 41 publications

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“…This could also be due to the perception that depots and LAIs are old-fashioned and they are reserved for the most chronic and disabled patients [138-140]. Furthermore, due to higher availability of oral atypical antipsychotics in the 1990s, with associated heavy marketing, the decline in prescription of depot has continued due to the assumptions that patients always prefer oral to depots even though clinician’s attitude towards these medications is marginally improved.…”

Section: Discussionmentioning

confidence: 99%

Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations

et al. 2012

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BackgroundCurrent guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). This review aims to describe the demographic and clinical characteristics of the ideal profile of the patient with schizophrenia treated with LAIs, through the analysis of nonrandomized studies.MethodsA systematic review of nonrandomized studies in English was performed attempting to analyze the factors related to the choice and use of LAIs in daily practice. The contents were outlined using the Cochrane methods for nonrandomized studies and the variables included demographic as well as clinical characteristics. The available literature did not allow any statistical analysis that could be used to identify the ideal profile of patients with schizophrenia to be treated with LAIs.ResultsEighty publications were selected and reviewed. Prevalence of LAI use ranged from 4.8% to 66%. The only demographic characteristics that were consistently assessed through retrieved studies were age (38.5 years in the 1970’s, 35.8 years in the 1980’s, 39.3 years in the 1990’s, to 39.5 years in the 2000’s) and gender (male > female).Efficacy was assessed through the use of various symptom scales and other indirect measurements; safety was assessed through extrapyramidal symptoms and the use of anticholinergic drugs, but these data were inconsistent and impossible to pool. Efficacy and safety results reported in the different studies yielded a good therapeutic profile with a maximum of 74% decrease in hospital admissions and the prevalence of extrapyramidal symptoms with LAIs consistently increased at 6, 12, 18, and 24 months (35.4%, 37.1%, 36.9%, and 41.3%, respectively).ConclusionsThis analysis of the available literature strongly suggests that further observational studies on patients with schizophrenia treated with LAIs are needed to systematically assess their demographic and clinical characteristics and the relationships between them and patient outcome.Besides the good efficacy and safety profile of LAIs, health care staff must also take into account the importance of establishing a therapeutic alliance with the patient and his/her relatives when selecting the most appropriate treatment. LAIs seem to be a good choice not only because of their good safety and efficacy profile, but also because they improve compliance, a key factor to improving adherence and to establishing a therapeutic alliance between patients with schizophrenia, their relatives, and their health care providers.

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Section: Discussionmentioning

confidence: 99%

Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations

et al. 2012

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“…Recent reviews have never been more vocal about their use in early-episode patients for similar reasons (provided schizophrenia has been diagnosed or clinically highly suspected), as these patients ''have more to lose'' [134,[157][158][159][160][161][162][163][164][165][166][167][168][169][170]. LAAPs may, if presented correctly, be more effective for maintaining medication continuity, preventing relapse, reducing the number and duration of rehospitalizations and, when achieving remission, holding this status [161,166,168,169,[171][172][173][174][175]. As LAAPs stay in the bloodstream for months compared with days for the oral formulation, patients who are non-adherent still have active treatment in their bloodstream for a substantial amount of time [176][177][178].…”

Section: Results Of Descriptivementioning

confidence: 99%

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

et al. 2015

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With continuous treatment, patients have a lower risk of relapse and remain relapse free for a longer period of time compared with placebo and intermittent treatment strategies. Moreover, 'success rates' in the intermittent treatment conditions are expected to be an overestimate of actual outcome rates. Therefore, continuous treatment remains the 'gold standard' for good clinical practice, particularly as, until now, only a few and rather general valid predictors for relapse in schizophrenia are known and subsequent relapses may contribute to functional deterioration as well as treatment resistance in patients with schizophrenia.

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“…Patients with FEP are more sensitive to antipsychotic drugs and show a rapid improvement in positive psychotic symptoms. 4 Thus, the optimum dose for individual patients and possible adverse effects of a drug may vary in clinical practice. The open-label design with flexible-dose treatment in this study simulates the clinical practice currently followed in hospital settings.…”

Section: Discussionmentioning

confidence: 99%

“… 3 Antipsychotic medications aid in the improvement of psychotic symptoms in patients with first-episode psychosis (FEP). 4 However, substantial clinical data indicate that lack of treatment and medication nonadherence increases the risk of clinical relapse in patients with FEP. 5 , 6 Recurrent psychotic episodes increase treatment costs and the risk of developing persistent psychotic symptoms and social dysfunction.…”

Section: Introductionmentioning

confidence: 99%

An open-label, flexible-dose study of paliperidone extended-release in Chinese patients with first-onset psychosis

Si¹,

Tan²,

Zhang³

et al. 2015

NDT

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BackgroundAntipsychotic medications facilitate the improvement of psychotic symptoms in patients with first-episode psychosis. Paliperidone extended-release (pali-ER), an atypical antipsychotic, was assessed for efficacy and safety in Chinese patients with first-episode psychosis.MethodsIn this 8-week, open-label, single-arm, multicenter study, patients with first-episode psychosis (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and a Positive and Negative Syndrome Scale (PANSS) total score ≥70 were treated with flexible-dose pali-ER tablets (3–12 mg/day). The primary efficacy endpoint was the percentage of patients with an increase of ≥8 points in Personal and Social Performance (PSP) score from baseline to day 56 (8 weeks). Secondary endpoints included reduction in PANSS total score, improvement in Clinical Global Impression-Severity score, PSP score, Subjective Well-being under Neuroleptics Scale score, and relationship between duration of untreated psychosis and PANSS or PSP. Incidences of treatment-emergent adverse events were used to evaluate safety.ResultsOverall, 283 of 294 patients (96%) achieved a ≥8-point increase in PSP (primary endpoint, analysis set). For the secondary efficacy endpoints, 284/306 patients (93%) had a ≥30% reduction in PANSS total score; 266/306 patients (87%) achieved a ≤3 Clinical Global Impression-Severity scale score, and 218/294 patients (74%) had a PSP score ≥71. The Subjective Well-being under Neuroleptics Scale score was improved from a baseline mean of 72.7 to 94.7 at endpoint. There was a negative correlation between duration of untreated psychosis and posttreatment PSP score and a positive correlation with posttreatment PANSS total score. The most common treatment-emergent adverse events were extrapyramidal symptoms (12%), and agitation, somnolence, and xerostomia (4% each).ConclusionAn 8-week, flexible-dose (3–12 mg/day) treatment with pali-ER resulted in significant improvements in psychotic symptoms and social functioning in Chinese patients with first-episode psychosis and was generally tolerable.

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Role of Long-Acting Injectable Second-Generation Antipsychotics in the Treatment of First-Episode Schizophrenia: A Clinical Perspective

Cited by 21 publications

References 41 publications

Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations

Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

An open-label, flexible-dose study of paliperidone extended-release in Chinese patients with first-onset psychosis

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