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Weight changes in people with early psychosis treated with oral or long-acting injectable aripiprazole. Schizophr Res 2023; 251:74-81. [PMID: 36587541 DOI: 10.1016/j.schres.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/26/2022] [Accepted: 11/15/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Weight gain remains a major problem in young people with psychosis treated with antipsychotic medication. Aripiprazole is now available in monthly long-acting injection (LAI) and daily oral tablet formulation, but information is lacking about differences in weight gain between the two formulations. We monitored for up to 24 months the weight changes associated with oral or LAI-administered aripiprazole and in a group who not prescribed any antipsychotic medication. METHODS Participants included 109 young people with early psychosis (n = 30 Oral, 41 LAI, 38 Nil antipsychotic) with a treatment completion median time of 15 months. Weight (kilogram) and body mass index (BMI) were recorded at 3 monthly intervals. Multilevel modelling analyses assessed the contribution of time and group on weight change. RESULTS Participants taking nil antipsychotics did not gain weight over time, while the two aripiprazole groups gained a combined average of 7.1 kg (SD = 5.0) or 1.9 BMI (SD = 0.4). An examination of formulation effects showed a significantly greater rate of change over time in the Oral group with a weight increase of approximately 11.0 kg (SD = 8.2) or 3.5 BMI (SD = 0.7, compared to the LAI group with a gain of 3.7 kg (SD = 2.1) or 0.8 BMI (SD = 0.1) in the LAI group. These differences could not be explained by demographic or clinical characteristics, medication dosage, or baseline weight. CONCLUSIONS While aripiprazole is generally considered relatively benign in terms of weight, it still poses a significant risk especially for people with early psychosis. However the current study suggests that the risk may be lower in those treated with LAI than with Oral formulation, consolidating the clinical utility of LAI.
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2
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Parmar A, Hulme D, Hacking D, Shymko G, Dragovic M, Terina G, Waters F. Aripiprazole in young people with early psychosis: a systematic review and meta-analysis of weight gain. Australas Psychiatry 2022; 30:90-94. [PMID: 35001673 DOI: 10.1177/10398562211037334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Aripiprazole is often prescribed to young people, although there remain unanswered questions about its effects on weight gain. This study undertook a meta-analysis of weight gain occurring in young people with early psychosis who were prescribed aripiprazole. METHOD A systematic search was conducted for studies reporting on aripiprazole and weight change in young people with a psychotic disorder. A meta-analysis integrated the data into an estimate of effect size. RESULTS Eleven studies met the inclusion criteria amounting to 886 participants (mean age 18 years). The results showed significant weight gain averaging 2.7 kg. These increases were associated with a longer duration of exposure to aripiprazole but not a higher dosage. CONCLUSIONS The results highlight the importance of regular patient monitoring and the early implementation of interventions to manage antipsychotic-related weight gain.
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Affiliation(s)
- Arti Parmar
- North Metropolitan Area Health Service - Mental Health, Perth, Australia
| | - Donald Hulme
- North Metropolitan Area Health Service - Mental Health; and Clinical Research Centre, North Metropolitan Health Service Mental Health, Graylands Hospital, Perth, WA, Australia
| | - Daniel Hacking
- Black Swan Health, Headspace Early Psychosis, Perth Australia
| | - Gordon Shymko
- Black Swan Health, Headspace Early Psychosis, Perth, WA, Australia.,South Metropolitan Health Service - Mental Health.,South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, WA, Australia
| | - Milan Dragovic
- Clinical Research Centre, North Metropolitan Health Service Mental Health, Graylands Hospital, Perth, WA, Australia.,Division of Psychiatry, The University of Western Australia, Crawley Perth, WA, Australia
| | | | - Flavie Waters
- Clinical Research Centre, North Metropolitan Health Service Mental Health, Graylands Hospital, Perth, WA, Australia.,Black Swan Health, headspace Early Psychosis, Perth, Osborne Park, WA, Australia.,South Metropolitan Health Service - Mental Health; and School of Psychological Sciences, The University of Western Australia, Crawley Perth, WA, Australia
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3
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Shymko G, Grace T, Jolly N, Dobson L, Hacking D, Parmar A, Kapi P, Waters F. Weight gain and metabolic screening in young people with early psychosis on long acting injectable antipsychotic medication (aripiprazole vs paliperidone). Early Interv Psychiatry 2021; 15:787-793. [PMID: 32715655 DOI: 10.1111/eip.13013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/07/2020] [Accepted: 05/24/2020] [Indexed: 12/11/2022]
Abstract
AIM Long-acting injectable (LAI)antipsychotics are often used in psychosis to assist with medication compliance and relapse prevention, although the weight gain and metabolic effects in young people are yet to be examined. This study examined the long-term effects of aripiprazole and paliperidone in LAI formulation on weight gain and metabolic parameters in young people with early episode psychosis. METHODS Weight gain and other metabolic effects of aripiprazole and paliperidone in LAI formulation were examined in 59 young people with early episode psychosis over a 12-month period. Changes in outcome measurements were examined at baseline and 3 monthly intervals. RESULTS The results showed that both aripiprazole and paliperidone were associated with time-dependent increases in weight. At 12 months, weight increased by an average of 7% (6 kg) with both aripiprazole and paliperidone relative to the baseline, and the percentage of overweight or obese people increased from 33% to 60%. There was no advantage of aripiprazole compared to paliperidone with regards to weight change, although aripiprazole was associated with lower triglycerides and prolactin levels. CONCLUSIONS Both LAI medications were associated with substantial weight increases over time. These results build on emerging evidence showing that aripiprazole is not weight neutral in young people. Our recommendation is that weight-management programs should be offered from the start of medication initiation.
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Affiliation(s)
- Gordon Shymko
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia.,South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, Western Australia, Australia
| | - Terina Grace
- Black Swan Health, Perth, Western Australia, Australia
| | - Nicole Jolly
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Louise Dobson
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Daniel Hacking
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Arti Parmar
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia.,South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, Western Australia, Australia
| | - Puanna Kapi
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia
| | - Flavie Waters
- Black Swan Health, headspace Early Psychosis, Perth, Western Australia, Australia.,Clinical Research Centre, North Metropolitan Health Service Mental Health, Graylands Hospital, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia
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4
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Rognoni C, Bertolani A, Jommi C. Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects. Clin Drug Investig 2021; 41:303-319. [PMID: 33686614 PMCID: PMC8004512 DOI: 10.1007/s40261-021-01000-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Second-generation antipsychotics (SGAs) for schizophrenia show different risk profiles, whose evidence has been evaluated through comparative reviews on randomized controlled trials (RCTs) and observational studies. METHODS We performed a systematic review and meta-analysis of weight gains, metabolic and cardiovascular side effects of SGAs, relying on both RCTs and observational studies, by comparing variations between the start of treatment and the end of follow-up. The systematic review refers to papers published from June 2009 to November 2020. PRISMA criteria were followed. No restrictions on heterogeneity level have been considered for meta-analysis. A test for the summary effect measure and heterogeneity (I2 metric) was used. RESULTS Seventy-nine papers were selected from 3076 studies (61% RCTs, 39% observational studies). Olanzapine and risperidone reported the greatest weight gain and olanzapine the largest BMI increase. Paliperidone showed the highest increase in total cholesterol, but is the only drug reporting an increase in the HDL cholesterol. Quetiapine XR showed the highest decrease in fasting glucose. Lurasidone showed the lowest increase in body weight and a reduction in BMI and was also the only treatment reporting a decrease in total cholesterol and triglycerides. The highest increase in systolic and diastolic blood pressure was reported by quetiapine XR. CONCLUSIONS Despite some limitations (differences in the mean dosages per patient and other side effects not included) this paper provides the first complete meta-analysis on SGAs in variations on metabolic risk profile between start of treatment and end of follow-up, with useful results for clinical practice and possibly for future economic evaluation studies.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy.
| | - Arianna Bertolani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy
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5
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Zhang Y, Geyfman A, Coffman B, Gill K, Ferrarelli F. Distinct alterations in resting-state electroencephalogram during eyes closed and eyes open and between morning and evening are present in first-episode psychosis patients. Schizophr Res 2021; 228:36-42. [PMID: 33434730 PMCID: PMC7987764 DOI: 10.1016/j.schres.2020.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
Abnormalities in resting-state electroencephalogram (rs-EEG) activity have been previously reported in schizophrenia. While most rs-EEG recordings were performed in patients with chronic schizophrenia during eyes closed (EC), only a handful of studies have investigated rs-EEG activity during both EC and eyes open (EO) conditions. It is also unknown whether EC and EO rs-EEG alterations are present at illness onset, and whether they change during the day. Here, we performed EC and EO rs-EEG recordings in the morning (AM) and evening (PM) in twenty-six first-episode psychosis (FEP) patients and seventeen matched healthy controls (HC). In AM/EC rs-EEG, a widespread reduction was found in low alpha power in FEP relative to HC. In PM/EC, the FEP group demonstrated a trend toward decreased theta power in parietal regions, while decreased high alpha power in frontal and left parietal regions was present during PM/EO. Moreover, reduced low alpha power during AM/EC was associated with worse positive symptoms. Altogether, those findings indicate that rs-EEG alterations are present in FEP patients at illness onset, that they are linked to the severity of their psychosis, and that distinct RS abnormalities can be detected in different conditions of visual alertness and time of the day. Future work should therefore account for those factors, which will help reduce variability of rs-EEG findings across studies and may serve as monitoring biomarkers of illness severity in schizophrenia and related psychotic disorders.
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Affiliation(s)
- Yingyi Zhang
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Alexandra Geyfman
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Brian Coffman
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Kathryn Gill
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
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Roy MA, Olivier D, Cambon A. De Kraepelin à McGorry : vision scientifique et récit expérientiel autour d’un changement de paradigme majeur. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088177ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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A 3-year prospective study on the metabolic effect of aripiprazole, quetiapine and ziprasidone: A pragmatic clinical trial in first episode psychosis patients. Eur Neuropsychopharmacol 2020; 39:46-55. [PMID: 32891516 DOI: 10.1016/j.euroneuro.2020.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 12/25/2022]
Abstract
Schizophrenia is a severe brain disorder with an excess morbidity and mortality partly due to a higher incidence of metabolic disturbances and cardio-vascular events. The exposure to antipsychotic treatment has been observed linked to these metabolic abnormalities. This study explores the metabolic effects of aripiprazol, quetiapine and ziprasidone in drug-naïve patients with a first-episode of psychosis, at long-term. Two-hundred and two patients with first-episode of psychosis were included in the study. Patients were randomly assigned to receive quetiapine, ziprasidone, or aripiprazole. Clinical, sociodemographic and anthropometric measures, as well as lipid and glyceamic parameters, were recorded at baseline and after three years of initiating antipsychotic treatment. Body weight and BMI increased significantly after 3 years of follow-up (F = 35.0, p<0.001; and F = 37.6, p<0.001, respectively). Most of the increase in weight occurred within the first year of treatment. The proportion of patients meeting criteria for obesity (5.6% vs 25.7%; p<0.001), hypercholesterolemia (23.2% vs 41.7%; p<0.001) and hypertriglyceridemia (5.8% vs 23.0%; p<0.001) increased significantly. Head-to-head comparisons between antipsychotic groups revealed that the ziprasidone group presented significantly smaller increments in weight (p = 0.034) and BMI (p = 0.020) than aripiprazole group. After 3 years of having presented a first episode of psychosis, patients show significant increments in body weight and BMI, as well as in lipid and glycaemic parameters leading to clinical metabolic disturbances. In this context, the first year is the critical period for weight gain and development of metabolic changes. In this study, ziprasidone produced smaller weight gain than aripiprazole.
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8
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Vázquez-Bourgon J, Mayoral-van Son J, Gómez-Revuelta M, Juncal-Ruiz M, Ortiz-García de la Foz V, Tordesillas-Gutiérrez D, Ayesa-Arriola R, Bioque M, Crespo-Facorro B. Treatment Discontinuation Impact on Long-Term (10-Year) Weight Gain and Lipid Metabolism in First-Episode Psychosis: Results From the PAFIP-10 Cohort. Int J Neuropsychopharmacol 2020; 24:1-7. [PMID: 32840607 PMCID: PMC7816683 DOI: 10.1093/ijnp/pyaa066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/02/2020] [Accepted: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with a first episode of psychosis (FEP) are at higher risk of gaining weight and presenting metabolic disturbances, partly related to antipsychotic exposure. Previous studies suggest that treatment discontinuation might have a positive impact on weight in schizophrenia. The aim of this study was to evaluate the effect of treatment discontinuation on weight and metabolic changes in a FEP cohort. METHODS A total of 209 FEP patients and 57 healthy controls were evaluated at study entry and prospectively at 10-year follow-up. Anthropometric measures and, clinical, metabolic, and sociodemographic data were collected. RESULTS Patients discontinuing antipsychotic treatment presented a significantly lower increase in weight and better metabolic parameter results than those still on antipsychotic treatment at 10-year follow-up. CONCLUSIONS Treatment discontinuation had a positive effect on the weight and metabolic changes observed in FEP patients; however, this effect was not sufficient to reaching a complete reversal to normal levels.
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Affiliation(s)
- Javier Vázquez-Bourgon
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain,Correspondence: Javier Vázquez-Bourgon, MD, PhD, Department of Psychiatry, University Hospital Marques de Valdecilla. Avda.Valdecilla s/n, Santander 39008, Spain ()
| | - Jaqueline Mayoral-van Son
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBiS, Sevilla, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - María Juncal-Ruiz
- Department of Psychiatry, Hospital Sierrallana - Instituto de Investigacion Marques de Valdecilla (IDIVAL), Torrelavega, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Víctor Ortiz-García de la Foz
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Diana Tordesillas-Gutiérrez
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, University Hospital Marqués de Valdecilla - Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Miquel Bioque
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Benedicto Crespo-Facorro
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain,Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBiS, Sevilla, Spain
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Dopamine D2 Receptor Occupancy Estimated From Plasma Concentrations of Four Different Antipsychotics and the Subjective Experience of Physical and Mental Well-Being in Schizophrenia: Results From the Randomized NeSSy Trial. J Clin Psychopharmacol 2020; 39:550-560. [PMID: 31688449 DOI: 10.1097/jcp.0000000000001131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Impaired subjective well-being in schizophrenia patients treated with antipsychotics has often been linked inter alia to the antidopaminergic effects of medication. Thus, it is important to capture the association between striatal dopamine D2 receptor occupancy (D2-RO) and global subjective well-being. We examined this association using data from our multicenter, randomized, double-blind Neuroleptic Strategy Study (NeSSy). METHODS An innovative double randomization process was used for allocation of patients to the specific treatment groups. Plasma drug concentrations were measured after 6 and 24 weeks of treatment to obtain the estimated D2-RO (eD2-RO) relative to literature values. We made an exploratory analysis of associations between eD2-RO and subjective well-being scores. One hundred two blood samples from 69 patients were available for the analysis. Because of the lack of a satisfactory occupancy model for quetiapine, only haloperidol, flupentixol, and olanzapine treatment groups were pooled, whereas aripiprazole data were analyzed separately, because of its partial agonistic properties. RESULTS In the pooled antagonist group, eD2-RO correlated negatively with the summarized well-being score. In a more detailed analysis, this association could be confirmed for all first-generation antipsychotic-treated patients, but not for the separate second-generation antipsychotic groups. In the aripiprazole group, higher eD2-RO was associated with impaired physical well-being, but had no association with mental well-being. CONCLUSIONS Our results suggest that high plasma levels and consequently high occupancy at D2 receptors are disadvantageous for subjective well-being, as distinct from the objective extrapyramidal side effects. To minimize patients' malaise, which disfavors adherence, implementation of therapeutic drug monitoring in the clinical routine may be useful.
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10
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Mustafa S, Bougie J, Miguelez M, Clerzius G, Rampakakis E, Proulx J, Malla A. Real-life assessment of aripiprazole monthly (Abilify Maintena) in schizophrenia: a Canadian naturalistic non-interventional prospective cohort study. BMC Psychiatry 2019; 19:114. [PMID: 30991969 PMCID: PMC6469112 DOI: 10.1186/s12888-019-2103-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/04/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With previously established efficacy of aripiprazole once-monthly injectable formulation (AOM) in pre-registration randomized controlled trials, the current study was designed to evaluate its effectiveness in patients treated for schizophrenia in regular clinical settings in Canada. METHODS Following their clinicians' decision to prescribe AOM, 193 patients with a diagnosis of schizophrenia, were recruited from 17 Canadian community or hospital-based settings. The primary outcome of global functioning was assessed with the Global Assessment of Functioning Scale (GAF) at 3-month intervals for 1 year. Secondary outcomes (social and occupational functioning and illness severity) and adverse drug reactions (ADR) were also assessed. RESULTS A majority of the 169 evaluable patients were within the first 5 years of diagnosis (early phase). A linear mixed model analysis showed a significant main effect of time (Type III test p < 0.001) after adjusting for baseline GAF score, with a change in mean GAF scores from 49 at baseline to 61 at 12 months. No differences between early vs late phase were observed. Results on secondary outcome measures of function (Social and Occupational Functioning Scale) and illness severity (Clinical Global Impression-Severity Scale and Brief Psychiatric Rating Scale) were similar. Serious ADRs were observed in 29 (14.6%) patients and akathisia in 18 (9.1%) patients. At month-12, significant (≥7%) weight gain was observed in 25.7% (n = 27/105) of patients. CONCLUSIONS Treatment with AOM is effective in improving symptoms and functioning in schizophrenia patients treated in regular clinical settings. Akathisia was infrequent while one quarter of patients gained clinically significant weight. TRIAL REGISTRATION Unique identifier: NCT02131415 . First posted: 06 May 2014.
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Affiliation(s)
- Sally Mustafa
- Douglas Mental Health University Institute, Montreal, Quebec Canada
| | | | - Maia Miguelez
- Otsuka Canada Pharmaceutical Inc, Montreal, Quebec Canada
| | | | | | - Jean Proulx
- Lundbeck Canada Inc, Montreal, Quebec Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, Montreal, Quebec Canada
- Department of Psychiatry, McGill University, Montreal, Quebec Canada
- ACCESS-Canada, 6625, boulevard LaSalle, Montreal, QC H4H 1R3 Canada
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11
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Mustafa S, Joober R, Lepage M, Iyer S, Shah J, Malla A. Predictors of 'all-cause discontinuation' of initial oral antipsychotic medication in first episode psychosis. Schizophr Res 2018; 201:287-293. [PMID: 29706449 DOI: 10.1016/j.schres.2018.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/08/2018] [Accepted: 04/14/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Discontinuation of the initial oral antipsychotic prescribed for a first episode of psychosis (FEP) can derail outcome. Our objective was to examine the rate of and time to all-cause discontinuation of the first antipsychotic prescribed and the factors influencing such discontinuation. METHODS In a sample of 390 FEP patients, we estimated the rate of and time to discontinuation of the initial antipsychotic over a one-year period. The effects of a number of putative predictors of discontinuation were estimated using regression analyses. RESULTS Rate of discontinuation of the first antipsychotic was 72%, with no difference between the 3 investigated antipsychotics (olanzapine (73%), risperidone (68%) and aripiprazole (75%)), (χ2 (2) = 1.89, p = 0.388). Mean time to discontinuation was 7.2 (4.6) months and was not different among the three antipsychotics (Log-rank χ2 (2) = 0.257, p = 0.879). Binary logistic regression showed that higher positive and negative symptoms remission and baseline functioning were associated with lower rates of discontinuation (Nagelkerke R2 = 0.36, χ2 (10) = 66.9, p < 0.001). Multiple linear regression showed the same predictors, in addition to male gender and less weight gain per month of exposure to the initial antipsychotic, to be associated with longer time to discontinuation (adjusted R2 = 0.336, F (9, 219) = 13.8, p < 0.001). CONCLUSION Discontinuation of the initial antipsychotic is a major concern in the course of treating FEP. Symptom relief, better functioning and lower side effects appear to be the major factors associated with continuing an antipsychotic medication.
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Affiliation(s)
- Sally Mustafa
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental Health University Institute, Montreal, QC, Canada.
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12
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Horska K, Ruda-Kucerova J, Drazanova E, Karpisek M, Demlova R, Kasparek T, Kotolova H. Aripiprazole-induced adverse metabolic alterations in polyI:C neurodevelopmental model of schizophrenia in rats. Neuropharmacology 2018; 123:148-158. [PMID: 28595931 DOI: 10.1016/j.neuropharm.2017.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/16/2017] [Accepted: 06/03/2017] [Indexed: 12/16/2022]
Abstract
Schizophrenia appears to be linked to higher incidence of metabolic syndrome even in the absence of antipsychotic treatment. Atypical antipsychotics substantially differ in their propensity to induce metabolic alterations. Aripiprazole is considered to represent an antipsychotic drug with low risk of metabolic syndrome development. The aim of this study was to evaluate metabolic phenotype of neurodevelopmental polyI:C rat model and assess metabolic effects of chronic aripiprazole treatment with regard to complex neuroendocrine regulations of energy homeostasis. Polyinosinic:polycytidylic acid (polyI:C) was administered subcutaneously at a dose of 8 mg/kg in 10 ml on gestational day 15 to female Wistar rats. For this study 20 polyI:C and 20 control adult male offspring were used, randomly divided into 2 groups per 10 animals for chronic aripiprazole treatment and vehicle. Aripiprazole (5 mg/kg, dissolved tablets, ABILIFY®) was administered once daily via oral gavage for a month. Altered lipid profile in polyI:C model was observed and a trend towards different dynamics of weight gain in polyI:C rats was noted in the absence of significant antipsychotic treatment effect. PolyI:C model was not associated with changes in other parameters i.e. adipokines, gastrointestinal hormones and cytokines levels. Aripiprazole did not influence body weight but it induced alterations in neurohumoral regulations. Leptin and GLP-1 serum levels were significantly reduced, while ghrelin level was elevated. Furthermore aripiprazole decreased serum levels of pro-inflammatory cytokines. Our data indicate dysregulation of adipokines and gastrointestinal hormones present after chronic treatment with aripiprazole which is considered metabolically neutral in the polyI:C model of schizophrenia.
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Affiliation(s)
- Katerina Horska
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Jana Ruda-Kucerova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Eva Drazanova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Scientific Instruments, ASCR, Brno, Czech Republic
| | - Michal Karpisek
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic; R&D Department, Biovendor - Laboratorni Medicina, Brno, Czech Republic
| | - Regina Demlova
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kasparek
- Department of Psychiatry, University Hospital and Masaryk University, Brno, Czech Republic
| | - Hana Kotolova
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
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Two-year effectiveness of risperidone and aripiprazole in the maintenance treatment of patients with recent-onset or chronic schizophrenia and related psychotic disorders: a retrospective multicenter study. Int Clin Psychopharmacol 2018; 33:147-154. [PMID: 29406406 DOI: 10.1097/yic.0000000000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to assess the comparative effectiveness of risperidone (RIS) versus aripiprazole (ARP) in patients with recent-onset or chronic schizophrenia during maintenance treatment and to examine the interaction between illness duration and the effectiveness of the treatment. All adult patients with schizophrenia and related disorders discharged from four psychiatric hospitals between 2006 and 2012 were screened and the 2-year continuation rates of monotherapy using RIS or ARP after discharge were examined retrospectively. The treatment continuation of the two drugs in patients with recent-onset (illness duration <5 years) or chronic schizophrenia (illness duration ≥5 years) and the moderator effect of illness duration on the effectiveness of the treatment were analyzed. Of 328 patients, 233 received RIS and 95 received ARP. No significant difference was found between the two drugs in the treatment continuation for the entire sample. However, there was a significant difference favoring ARP in the recent-onset subgroup mainly because of differences in tolerability, whereas RIS tended to present better outcomes in patients with chronic illness. Furthermore, there was a significant variation in the effectiveness of the treatment between recent-onset and chronic schizophrenia. Our results suggest that illness duration is an important moderator in terms of the long-term effectiveness of the two drugs.
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Nguyen C, Novac A, Hazen J, Howard P, Tieu R, Bota RG. Weight gain changes in patients with aripiprazole monotherapy compared with aripiprazole-antidepressant polypharmacy in an outpatient sample. J Psychopharmacol 2018; 32:423-429. [PMID: 29215304 DOI: 10.1177/0269881117742659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study seeks to evaluate the weight gain effect within a community-based population of patients with diagnoses of depression, mood disorder, and schizophrenia receiving aripiprazole over a period of at least 6 months. METHOD The four million members of Kaiser Permanente of Southern California (KPSC) were queried for a four-year period between January 1, 2010 and December 31, 2013. The initial cohort comprised 25,682 KPSC members who received at least one dispense of aripiprazole. This initial cohort was split into those who received aripiprazole as a monotherapy ("Alone" group) and those who were given aripiprazole as part of a combination therapy. The group of patients that received aripiprazole and antidepressant with high serotonin reuptake inhibition we called "High" group while the group receiving aripiprazole and bupropion combination we called "Low" serotonin group. We compared the primary endpoint of mean percent weight change from baseline after 180 days of continuous treatment between the three groups. Three pairwise comparisons were made: High versus Alone, Low versus Alone, and Low versus High, using adjusted and unadjusted linear regression models. RESULTS Within this population, patients on aripiprazole monotherapy showed statistically significant weight gain in all three groups. However, there was no statistically significant difference in weight gain between the aripiprazole monotherapy, the high serotonergic combination group, and the low serotonergic combination group. This finding applied even within the subset of patients who were considered obese (body mass index > 30). CONCLUSIONS The results suggest that weight gain is unchanged by combination treatments, but further research is required.
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Affiliation(s)
- Charles Nguyen
- 1 University of California Irvine, Orange, USA.,2 Long Beach VA Hospital, Long Beach, USA
| | | | | | | | - Ryan Tieu
- 5 Department of Research and Innovations, Regional Research Statistical Support, Kaiser Permanente Southern California, Oakland, USA
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Long-term metabolic effects of aripiprazole, ziprasidone and quetiapine: a pragmatic clinical trial in drug-naïve patients with a first-episode of non-affective psychosis. Psychopharmacology (Berl) 2018; 235:245-255. [PMID: 29075885 DOI: 10.1007/s00213-017-4763-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The use of second-generation antipsychotics (SGA) has been associated with metabolic changes. However, there are differences in the metabolic profile between SGAs. We have previously observed that ziprasidone had a more benign early metabolic profile compared to aripiprazole and quetiapine. However, a long-term follow-up is preferred to detect clinically relevant impairment in metabolic parameters. We aimed to compare the effect of aripiprazole, ziprasidone, and quetiapine on metabolic measures in first-episode non-affective psychosis patients after 1 year of treatment. MATERIAL AND METHODS One hundred and sixty-five drug-naïve patients, suffering from a first episode of non-affective psychosis, were randomly assigned to receive quetiapine, ziprasidone, or aripiprazole. Weight and glycemic/lipid parameters were recorded at baseline and after 1 year of treatment. RESULTS After 1 year of antipsychotic treatment, we found significant increments in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and the triglyceride/HDL index in the sample as a whole. These changes produced a significant rise in the percentage of patients with obesity, hypercholesterolemia, and hypertriglyceridemia. However, when comparing the differential effect of each antipsychotic medication, we found no significant differences in any of the metabolic parameters between antipsychotics groups after 1 year of treatment. CONCLUSION We concluded that the antipsychotics studied present similar metabolic profiles. However, the primary exposure to SGAs during the first year of psychosis was associated with significant increases in weight and metabolic parameters, leading to increments in obesity, hypertriglyceridemia, and hypercholesterolemia.
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Malla A, Ota A, Nagamizu K, Perry P, Weiller E, Baker RA. The effect of brexpiprazole in adult outpatients with early-episode schizophrenia: an exploratory study. Int Clin Psychopharmacol 2016; 31:307-14. [PMID: 27571460 PMCID: PMC5049948 DOI: 10.1097/yic.0000000000000140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this study was to evaluate flexibly dosed brexpiprazole for early-episode schizophrenia through the assessment of efficacy, social functioning, and tolerability. This was an exploratory, 16-week, open-label, flexible-dose (1, 2, 3, or 4 mg/day; target dose 3 mg/day) study in outpatients with early-episode schizophrenia (18-35 years old, ≤5 years' duration of illness). Efficacy was assessed by the Positive and Negative Syndrome Scale score (PANSS) and social functioning was assessed by changes from baseline in PANSS modified prosocial subscale, personal and social performance (PSP), and specific levels of functioning (SLOF) scales. Safety and tolerability were also evaluated. Overall, 25/49 patients completed the study. Symptoms of schizophrenia improved over the entire treatment period, as evidenced by reductions in PANSS total score from baseline (least squares mean change at week 16: -10.2). Improvements in social functioning were shown by least squares mean changes from baseline at week 16 in the PANSS prosocial subscale (-2.0), PSP (6.6), and SLOF (13.1). Brexpiprazole was generally well tolerated; the most common adverse events were insomnia (7/49 patients), somnolence (4/49), sedation, weight increase, and nausea (each 3/49). Brexpiprazole may represent a novel and effective treatment strategy for patients with early-episode schizophrenia and may be effective for improving social function.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ai Ota
- Otsuka Pharmaceutical Co., Tokyo, Japan
| | | | - Pamela Perry
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
| | | | - Ross A. Baker
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey, USA
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