RATIONALE: Evidence on sequential trial with atypical antipsychotics has been scarce. OBJECTIVES: We conducted an algorithm-based antipsychotic pharmacotherapy. MATERIALS AND METHODS: In this open-label study, patients with schizophrenia (DSM-IV) were treated with antipsychotic monotherapy, step-by-step, with each trial lasting up to 8 weeks. At baseline, they were highly symptomatic to score more than 54 in the total Brief Psychiatric Rating Scale (BPRS(1-7)) score. When the posttreatment BPRS score was above 70% of the baseline, they were subsequently treated with another and up to three atypicals. Basically, anticholinergics were prohibited, and only adjunctive allowed was lorazepam. The secondary endpoint was a clinical status good enough to be discharged for 66 inpatients and a successful continuation therapy with the same antipsychotic agent for more than 6 months for 12 outpatients. RESULTS:Three groups of 26 patients each were randomized toOlanzapine, Quetiapine, or Risperidone. Thirty-nine (50%) responded to the first agent (Olanzapine16, Quetiapine9, Risperidone14), and 14 responded to the second. Only two showed response to the third, and 16 failed to respond to all three antipsychotics, with only 7 dropouts. Overall, there were 22 Olanzapine, 14 Quetiapine, and 19 Risperidone responders. Based on the secondary outcome, 20 Olanzapine-treated (average maximum dose, 15.4 mg), 10 Quetiapine-treated (418 mg), and 20 Risperidone-treated (4.10 mg) patients responded. The difference in response as the first choice was significant (p < 0.05). Relative doses of those failing to respond were comparable (Olanzapine 18.3 mg, Quetiapine 564 mg, Risperidone5.47 mg). Extrapyramidal symptoms did not change significantly. CONCLUSIONS: When the first atypical antipsychotic is inadequate, switching to the second is worth trying, although some remain treatment-refractory. Quetiapine may be inferior to Olanzapine and Risperidone in symptomatic patients.
RCT Entities:
RATIONALE: Evidence on sequential trial with atypical antipsychotics has been scarce. OBJECTIVES: We conducted an algorithm-based antipsychotic pharmacotherapy. MATERIALS AND METHODS: In this open-label study, patients with schizophrenia (DSM-IV) were treated with antipsychotic monotherapy, step-by-step, with each trial lasting up to 8 weeks. At baseline, they were highly symptomatic to score more than 54 in the total Brief Psychiatric Rating Scale (BPRS(1-7)) score. When the posttreatment BPRS score was above 70% of the baseline, they were subsequently treated with another and up to three atypicals. Basically, anticholinergics were prohibited, and only adjunctive allowed was lorazepam. The secondary endpoint was a clinical status good enough to be discharged for 66 inpatients and a successful continuation therapy with the same antipsychotic agent for more than 6 months for 12 outpatients. RESULTS: Three groups of 26 patients each were randomized to Olanzapine, Quetiapine, or Risperidone. Thirty-nine (50%) responded to the first agent (Olanzapine16, Quetiapine9, Risperidone14), and 14 responded to the second. Only two showed response to the third, and 16 failed to respond to all three antipsychotics, with only 7 dropouts. Overall, there were 22 Olanzapine, 14 Quetiapine, and 19 Risperidone responders. Based on the secondary outcome, 20 Olanzapine-treated (average maximum dose, 15.4 mg), 10 Quetiapine-treated (418 mg), and 20 Risperidone-treated (4.10 mg) patients responded. The difference in response as the first choice was significant (p < 0.05). Relative doses of those failing to respond were comparable (Olanzapine 18.3 mg, Quetiapine 564 mg, Risperidone5.47 mg). Extrapyramidal symptoms did not change significantly. CONCLUSIONS: When the first atypical antipsychotic is inadequate, switching to the second is worth trying, although some remain treatment-refractory. Quetiapine may be inferior to Olanzapine and Risperidone in symptomatic patients.
Authors: Maria A Rettenbacher; Christoph Ebenbichler; Alex Hofer; Georg Kemmler; Susanne Baumgartner; Monika Edlinger; Martina Hummer; Monika Lechleitner; W Wolfgang Fleischhacker Journal: Int Clin Psychopharmacol Date: 2006-11 Impact factor: 1.659
Authors: Stefan Leucht; Inge Winter-van Rossum; Stephan Heres; Celso Arango; W Wolfgang Fleischhacker; Birte Glenthøj; Marion Leboyer; F Markus Leweke; Shôn Lewis; Phillip McGuire; Andreas Meyer-Lindenberg; Dan Rujescu; Shitij Kapur; René S Kahn; Iris E Sommer Journal: Schizophr Bull Date: 2015-03-18 Impact factor: 9.306
Authors: Nicolas M Furiak; Haya Ascher-Svanum; Robert W Klein; Lee J Smolen; Anthony H Lawson; Robert R Conley; Steven D Culler Journal: Cost Eff Resour Alloc Date: 2009-04-07
Authors: Myrto T Samara; Elisabeth Klupp; Bartosz Helfer; Philipp H Rothe; Johannes Schneider-Thoma; Stefan Leucht Journal: Cochrane Database Syst Rev Date: 2018-05-11