[Present data and treatment schedule of aripiprazole in the treatment of schizophrenia]

Aripiprazole versus olanzapine in the treatment of schizophrenia: a clinical study from India

OBJECTIVE

The aim of the study was to compare efficacy and tolerability of aripiprazole with olanzapine in the short-term treatment of schizophrenia in an Indian population.

METHOD

This was a randomized double-blind controlled study comparing aripiprazole and olanzapine in the treatment of individuals with schizophrenia in an inpatient clinical setting. Sixty subjects between 18 and 65 years of age, who fulfilled the ICD-10 criteria for schizophrenia, were enrolled. Patients' detailed demographic and clinical evaluation was conducted and they were administered efficacy assessment scales (BPRS, PANSS) and safety assessments scale (Simpson Angus Scale, UKU side effect rating scale) at regular intervals of 1 week each throughout the study. The laboratory tests (complete haemogram, electrocardiogram (ECG), lipid profile, liver and renal function tests) were conducted at baseline and after 1-week intervals until 6 weeks of treatment. The patients were randomly allocated to receive either aripiprazole or olanzapine.

RESULTS

Both aripiprazole and olanzapine led to significant reductions on BPRS and PANSS total score over a period of 6 weeks. Weight gain was observed more frequently in the olanzapine-treated group (22.20%) as compared to aripiprazole (7.70%). More patients in the aripiprazole treatment group required comedications (trihexiphenidyl and lorazepam) than olanzapine recipients.

CONCLUSION

This study demonstrates that aripiprazole is equally efficacious as olanzapine in the treatment of schizophrenia. Aripiprazole has a more benign side effect profile (weight gain, blood sugar level, lipid profile) as compared to olanzapine in the short-term treatment of schizophrenia. This study is the first in an Indian population to have compared aripiprazole and olanzapine.

Descriptive analyses of the aripiprazole arm in the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE)

A recent randomized, open-label, relapse prevention trial (ConstaTRE) compared outcomes with risperidone long-acting injectable (RLAI) versus the oral atypical antipsychotic quetiapine. This study also included a small descriptive arm in which patients could also be randomized to aripiprazole. Results of this exploratory analysis are described here. Clinically stable adults with schizophrenia or schizoaffective disorder previously treated with oral risperidone, olanzapine, or an oral conventional antipsychotic were randomized to RLAI or aripiprazole. Efficacy and tolerability were monitored for up to 24 months. A total of 45 patients were treated with aripiprazole (10-30 mg/day) and 329 patients with RLAI (25-50 mg i.m. every 2 weeks). Relapse occurred in 27.3% (95% CI: 15.0-42.8%) of aripiprazole-treated and 16.5% (95% CI: 12.7-21.0%) of RLAI-treated patients. Kaplan-Meier estimates of mean (standard error) relapse-free period were 313.7 (20.4) days for aripiprazole and 607.1 (11.4) days for RLAI patients. Remission was achieved by 34.1% (95% CI: 20.5-49.9%) of aripiprazole and 51.1% (95% CI: 45.5-56.6%) of RLAI patients. Clinical global impression-change was improved ("minimally improved" to "very much improved") in 26.4% with RLAI and 15.9% with aripiprazole patients. Tolerability was generally good for both treatment groups. Weight gain (7.0% with RLAI vs. 4.4% with aripiprazole), extrapyramidal adverse events (AEs) (10.3% vs. 4.4%), and potentially prolactin-related AEs (4.6% vs. 0%) were more common with RLAI treatment, and gastrointestinal disorders were more common in aripiprazole-treated patients (22.2% vs. 6.1%). Time-to-relapse in stable patients with schizophrenia or schizoaffective disorder was numerically longer in RLAI-treated patients than in aripiprazole-treated patients although not statistically significant. Both treatments were generally well tolerated.