Systematic meta-review of depot antipsychotic drugs for people with schizophrenia

Adams, Clive E; Fenton, Mark; Quraishi, Seema; David, Anthony S.

doi:10.1192/bjp.179.4.290

Cited by 265 publications

(203 citation statements)

References 30 publications

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“…Meta-analytic review of first-generation depots found little difference between individual medications. 5 No direct comparisons of risperidone long-acting injection with the first-generation depots are available except for one open, 6-month randomised study that showed favourable outcome for risperidone long-acting injection compared with zuclopenthixol decanoate for individuals with comorbid substance misuse. 6 Due to the growing trend towards the use of second-generation antipsychotics in general, 7 including risperidone long-acting injection, despite the lack of head-to-head evidence noted above, we aimed to retrospectively identify and measure the outcome of patients started on: risperidone long-acting injection, zuclopenthixol decanoate, flupentixol decanoate, fluphenazine decanoate, pipothiazine palmitate and haloperidol decanoate.…”

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confidence: 99%

Comparison of the effectiveness of depot antipsychotics in routine clinical practice

et al. 2010

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Aims and methodTo compare effectiveness of long-acting injections in schizophrenia and related psychoses in Lanarkshire, Scotland, from 2002 to 2008. We retrospectively assigned Clinical Global Impression (CGI) scores and examined discontinuation and hospitalisation rates.ResultsRisperidone, zuclopenthixol and flupentixol were associated with CGI improvement in 72-74% of individuals. Zuclopenthixol was associated with lower rates of discontinuation as a result of inefficacy compared with risperidone (hazard ratio (HR) = 0.11, 95% CI 0.05-0.27) and flupenthixol (HR = 0.14, 95% CI 0.05-0.39), and lower rates of hospitalisation compared with risperidone (HR = 0.32, 95% CI 0.17-0.56) and flupentixol (HR = 0.34, 95% CI 0.16-0.71). ‘Very much improved’ or ‘much improved’ on the CGI was seen in risperidone (29%), zuclopenthixol (16%) and flupentixol (37%), P<0.001.Clinical implicationsNo long-acting injection was clearly superior in all our outcome measures, supporting the continued need for a variety of long-acting depot antipsychotics to optimise the treatment of the range of patients seen in clinical practice.

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Comparison of the effectiveness of depot antipsychotics in routine clinical practice

et al. 2010

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“…Quando pacientes com esquizofrenia consentem tomar a medicação, seja por via oral ou intramuscular, não se observa diferença quanto à eficácia terapêutica entre antipsicóticos de ação curta e prolongada (1)(2) . forma, este procedimento exige cuidado (6) .…”

Section: Indicação E Início Do Tratamentounclassified

Antipsicóticos de ação prolongada no tratamento de manutenção da esquizofrenia. Parte II. O manejo do medicamento, integração da equipe multidisciplinar e perspectivas com a formulação de antipsicóticos de nova geração de ação prolongada

Bechelli

2003

Rev. Latino-Am. Enfermagem

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Nesta segunda parte é abordado, entre os diversos tópicos, a indicação e o início do tratamento, a variação individual da dose e do intervalo entre as administrações, a freqüência das consultas e estratégias na recaída na vigência do tratamento. Considerando-se que a baixa adesão ao tratamento é um dos fatores principais associados à ocorrência de exacerbação da sintomatologia, que os agentes de nova geração, mesmo com menor freqüência de efeitos colaterais extrapiramidais e melhor tolerabilidade de forma geral, não modificaram esta condição em relação aos convencionais e tendo-se em conta a superioridade dos depot em relação aos compostos convencionais administrados v.o., a formulação de medicamentos de nova geração com ação prolongada certamente poderá favorecer a adesão, a regularidade ao tratamento e a prevenção de recaída em pacientes com esquizofrenia. Ao lado destas observações, é de grande importância a participação da família no tratamento, bem como a atitude e a integração da equipe na execução das diversas tarefas.

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“…Depot injections, in particular, have worked well to deliver antipsychotic medications over long periods of time with enhanced efficacy over oral dosing (Adams et al 2001;Gastpar et al 2005). However, limitations of depot formulations restrict more significant improvements in adherence and efficacy.…”

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confidence: 99%

Pharmacokinetic and behavioral characterization of a long-term antipsychotic delivery system in rodents and rabbits

et al. 2006

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. Pharmacokinetic and behavioral characterization of a longterm antipsychotic delivery system in rodents and rabbits. Retrieved from http://repository.upenn.edu/mse_papers/122Pharmacokinetic and behavioral characterization of a longterm antipsychotic delivery system in rodents and rabbits AbstractRationale: Non-adherence with medication remains the major correctable cause of poor outcome in schizophrenia. However, few treatments have addressed this major determinant of outcome with novel longterm delivery systems.Objectives: The aim of this study was to provide biological proof of concept for a long-term implantable antipsychotic delivery system in rodents and rabbits.Materials and methods: Implantable formulations of haloperidol were created using biodegradable polymers. Implants were characterized for in vitro release and in vivo behavior using prepulse inhibition of startle in rats and mice, as well as pharmacokinetics in rabbits.Results: Behavioral measures demonstrate the effectiveness of haloperidol implants delivering 1 mg/kg in mice and 0.6 mg/kg in rats to block amphetamine (10 mg/kg) in mice or apomorphine (0.5 mg/kg) in rats. Additionally, we demonstrate the pattern of release from single polymer implants for 1 year in rabbits. Conclusions:The current study suggests that implantable formulations are a viable approach to providing longterm delivery of antipsychotic medications in vivo using animal models of behavior and pharmacokinetics. In contrast to depot formulations, implantable formulations could last 6 months or longer. Additionally, implants can be removed throughout the delivery interval, offering a degree of reversibility not available with depot formulations. AbstractRationale Non-adherence with medication remains the major correctable cause of poor outcome in schizophrenia. However, few treatments have addressed this major determinant of outcome with novel long-term delivery systems. Objectives The aim of this study was to provide biological proof of concept for a long-term implantable antipsychotic delivery system in rodents and rabbits. Materials and methods Implantable formulations of haloperidol were created using biodegradable polymers. Implants were characterized for in vitro release and in vivo behavior using prepulse inhibition of startle in rats and mice, as well as pharmacokinetics in rabbits. Results Behavioral measures demonstrate the effectiveness of haloperidol implants delivering 1 mg/kg in mice and 0.6 mg/kg in rats to block amphetamine (10 mg/kg) in mice or apomorphine (0.5 mg/kg) in rats. Additionally, we demonstrate the pattern of release from single polymer implants for 1 year in rabbits. Conclusions The current study suggests that implantable formulations are a viable approach to providing long-term delivery of antipsychotic medications in vivo using animal models of behavior and pharmacokinetics. In contrast to depot formulations, implantable formulations could last 6 months or longer. Additionally, implants can be removed throughout the delivery interval, offering a ...

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Systematic meta-review of depot antipsychotic drugs for people with schizophrenia

Cited by 265 publications

References 30 publications

Comparison of the effectiveness of depot antipsychotics in routine clinical practice

Comparison of the effectiveness of depot antipsychotics in routine clinical practice

Antipsicóticos de ação prolongada no tratamento de manutenção da esquizofrenia. Parte II. O manejo do medicamento, integração da equipe multidisciplinar e perspectivas com a formulação de antipsicóticos de nova geração de ação prolongada

Pharmacokinetic and behavioral characterization of a long-term antipsychotic delivery system in rodents and rabbits

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