Jerome H Taylor1,2, Scott Appel3, Matthew Eli1,2, Aaron Alexander-Bloch1,2, Lawrence Maayan1, Raquel E Gur1,2, Michael H Bloch4. 1. Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 2. Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Department of Psychiatry, Child Study Center, Yale University, New Haven, Connecticut, USA.
Abstract
Objectives: We investigated the time course of clinical response in the Treatment of Early Onset Schizophrenia Spectrum Disorders Study (TEOSS). Methods: TEOSS randomized 119 predominantly outpatient youth ages 8-19 years with schizophrenia or schizoaffective disorder to 8 weeks of treatment with molindone, risperidone, or olanzapine. We used proportional hazards regression to determine whether these three antipsychotics differed in the time until clinical response, defined as the time from treatment initiation to the point of achieving a Clinical Global Impressions-Improvement (CGI-I) scale score of 1 ("very much improved") or 2 ("much improved") that was maintained until week 8. Results: Of the 116 youth who initiated treatment, 56 (48%) achieved clinical response. Among clinical responders, the median (±interquartile range) time until clinical response was 4.0 (±4.0) weeks for olanzapine, 4.5 (±4.0) weeks for risperidone, and 6.0 (±4.0) weeks for molindone. There were no significant differences in time course for clinical response between medications (p = 0.84). Youth without symptom improvement (CGI-I ≥ 4) after 3 weeks were more likely to be clinical nonresponders at week 8 (relative risk ratio = 1.98, 95% confidence interval 1.29-3.05), compared with youth with at-least-minimal symptom improvement after 3 weeks when looking at all antipsychotics combined. Conclusion: To our knowledge, our study is the first to investigate medication differences in treatment response timing in early onset schizophrenia spectrum disorders. Clinical response times for molindone, risperidone, and olanzapine were not significantly different. Furthermore, while lack of early improvement predicted clinical nonresponse, whether or not to continue antipsychotic treatment after 3 or more weeks without symptom improvement should be based on clinical judgment after weighing potential risks, benefits, and alternatives. ClinicalTrials.gov Identifier: NCT00053703.
Objectives: We investigated the time course of clinical response in the Treatment of Early Onset Schizophrenia Spectrum Disorders Study (TEOSS). Methods: TEOSS randomized 119 predominantly outpatient youth ages 8-19 years with schizophrenia or schizoaffective disorder to 8 weeks of treatment with molindone, risperidone, or olanzapine. We used proportional hazards regression to determine whether these three antipsychotics differed in the time until clinical response, defined as the time from treatment initiation to the point of achieving a Clinical Global Impressions-Improvement (CGI-I) scale score of 1 ("very much improved") or 2 ("much improved") that was maintained until week 8. Results: Of the 116 youth who initiated treatment, 56 (48%) achieved clinical response. Among clinical responders, the median (±interquartile range) time until clinical response was 4.0 (±4.0) weeks for olanzapine, 4.5 (±4.0) weeks for risperidone, and 6.0 (±4.0) weeks for molindone. There were no significant differences in time course for clinical response between medications (p = 0.84). Youth without symptom improvement (CGI-I ≥ 4) after 3 weeks were more likely to be clinical nonresponders at week 8 (relative risk ratio = 1.98, 95% confidence interval 1.29-3.05), compared with youth with at-least-minimal symptom improvement after 3 weeks when looking at all antipsychotics combined. Conclusion: To our knowledge, our study is the first to investigate medication differences in treatment response timing in early onset schizophrenia spectrum disorders. Clinical response times for molindone, risperidone, and olanzapine were not significantly different. Furthermore, while lack of early improvement predicted clinical nonresponse, whether or not to continue antipsychotic treatment after 3 or more weeks without symptom improvement should be based on clinical judgment after weighing potential risks, benefits, and alternatives. ClinicalTrials.gov Identifier: NCT00053703.
Entities:
Keywords:
antipsychotic; children and adolescents; early intervention; pediatric; psychosis; randomized controlled trial
Authors: Juan A Gallego; Delbert G Robinson; Serge M Sevy; Barbara Napolitano; Joanne McCormack; Martin L Lesser; John M Kane Journal: J Clin Psychiatry Date: 2011-09-06 Impact factor: 4.384
Authors: Cynthia Z Burton; Ivy F Tso; Ricardo E Carrión; Tara Niendam; Steven Adelsheim; Andrea M Auther; Barbara A Cornblatt; Cameron S Carter; Ryan Melton; Tamara G Sale; Stephan F Taylor; William R McFarlane Journal: Schizophr Res Date: 2019-08-06 Impact factor: 4.939
Authors: Jean A Frazier; Anthony J Giuliano; Jacqueline L Johnson; Lauren Yakutis; Eric A Youngstrom; David Breiger; Linmarie Sikich; Robert L Findling; Jon McClellan; Robert M Hamer; Benedetto Vitiello; Jeffrey A Lieberman; Stephen R Hooper Journal: J Am Acad Child Adolesc Psychiatry Date: 2012-03-13 Impact factor: 8.829
Authors: Martin Cloutier; Myrlene Sanon Aigbogun; Annie Guerin; Roy Nitulescu; Agnihotram V Ramanakumar; Siddhesh A Kamat; Michael DeLucia; Ruth Duffy; Susan N Legacy; Crystal Henderson; Clement Francois; Eric Wu Journal: J Clin Psychiatry Date: 2016-06 Impact factor: 4.384
Authors: Luis Alameda; Abhishekh Ashok; Suzanne Avery; Ali Bani-Fatemi; Susan Berkhout; Mike Best; Kelsey Bonfils; Marco Colizzi; Maria Dauvermann; Stefan Du Plessis; Dominic Dwyer; Emily Eisner; Suhas Ganesh; Dennis Hernaus; Dhruva Ithal; Chantel Kowalchuk; Tina Kristensen; Katie Lavigne; Ellen Lee; Imke Lemmers-Jansen; Brian O'Donoghue; Lindsay Oliver; Oladunni Oluwoye; Min Tae Park; Pasquale Di Carlo; Helena Passarelli Giroud Joaquim; Ana Pinheiro; Ian Ramsay; Victoria Rodriguez; Musa Sami; Sunaina Soni; Susan Sonnenschein; Jerome Taylor; Michael Thomas; Anna Waterreus; Jessica Wojtalik; Zhuoya Yang; Robin Emsley; Sanja Kilian Journal: Psychiatry Res Date: 2019-11-09 Impact factor: 3.222
Authors: Hadel A Abo El-Enin; Marwa F Ahmed; Ibrahim A Naguib; Shaymaa W El-Far; Mohammed M Ghoneim; Izzeddin Alsalahat; Hend Mohamed Abdel-Bar Journal: Pharmaceuticals (Basel) Date: 2022-02-18