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Giron‐Hernandez C, Han JH, Alberio R, Singh A, García-Portilla MP, Pompili M, Knight RK, Richarz U, Gopal S, Antunes J. Efficacy and Safety of Paliperidone Palmitate 6-Month versus Paliperidone Palmitate 3-Month Long-Acting Injectable in European Patients with Schizophrenia: A Post Hoc Analysis of a Global Phase-3 Double-Blind Randomized Non-Inferiority Study. Neuropsychiatr Dis Treat 2023; 19:895-906. [PMID: 37077705 PMCID: PMC10108905 DOI: 10.2147/ndt.s400342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/22/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose To examine efficacy and safety of paliperidone palmitate (PP) 6-month (PP6M) vs PP3-month (PP3M) long acting injectable (LAI) in patients with schizophrenia from European sites previously stabilized on PP3M or PP1-month (PP1M). Methods This post-hoc subgroup analysis used data from a global phase-3 double-blind (DB) randomized non-inferiority study (NCT03345342). Patients were randomized (2:1, respectively) to receive dorsogluteal injections of PP6M (700 mg eq. or 1000 mg eq.) or PP3M (350 mg eq. or 525 mg eq.) in the 12-month DB phase. Primary endpoint was time-to-relapse during the DB phase, using a Kaplan-Meier cumulative survival estimate (non-inferiority margin 95% CI lower bound larger than prespecified as -10%). Treatment emergent adverse events (TEAEs), physical examinations, and laboratory tests were also evaluated. Results A total of 384 patients who entered the DB phase were included in European sites (PP6M, n = 260; PP3M, n = 124) with a mean age similar in both groups (mean age [SD] years: PP6M, 40.0 [11.39]; PP3M, 38.8 [10.41]). Baseline characteristics were similar across both groups. The number of patients who experienced a relapse during DB phase were PP6M: 18 (6.9%) vs PP3M: 3 (2.4%) with percentage relapse-free difference of -4.9% (95% CI: -9.2%, -0.5%), thus achieving non-inferiority criteria. Secondary efficacy endpoints indicated comparable improvements. Incidence of TEAEs was similar between PP6M (58.8%) and PP3M (54.8%) groups. Nasopharyngitis, headache, increased weight, and injection-site pain were the most common TEAEs. Conclusion The efficacy of PP6M was non-inferior to that of PP3M in preventing relapse in the European subgroup previously treated with PP1M or PP3M, which was consistent with the global study. No new safety signals were identified.
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Affiliation(s)
| | - Joong Hee Han
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | - Arun Singh
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Maria Paz García-Portilla
- Department of Psychiatry, Universidad de Oviedo, Instituto Sanitario Del Principado de Asturias (ISPA) and CIBERSAM, Oviedo, Spain
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - R Karl Knight
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Ute Richarz
- Janssen Global Services LLC, Cilag Int., Zug, Switzerland
| | - Srihari Gopal
- Janssen Research & Development, LLC, Titusville, NJ, USA
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - José Antunes
- EMEA Medical Affairs, Janssen-Cilag, Porto Salvo, Portugal
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Peritogiannis V, Tsoli F, Gioti P, Bakola M, Jelastopulu E. Use of Long-Acting Injectable Antipsychotics in a Clinical Sample of Community-Dwelling Patients with Schizophrenia-Spectrum Disorders in Rural Greece. J Clin Med 2023; 12:jcm12072508. [PMID: 37048591 PMCID: PMC10095177 DOI: 10.3390/jcm12072508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Data on the use of long-acting injectable antipsychotics (LAIs) in rural community mental healthcare settings are scarce. This study aimed to investigate the prescription patterns of LAIs in a clinical sample of patients with schizophrenia-spectrum disorders in rural Greece. All patients with schizophrenia-spectrum disorders who regularly attend the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T) in northwestern Greece were included in the study. The sample consists of 87 patients (59 males and 28 females) with a mean age of 54.4 years and a mean illness duration of 28 years. Most patients (72.4%) received antipsychotic monotherapy, and nearly 30% received an LAI formulation, mostly a second-generation LAI (20 of 26 patients, 76.9%). The treatment regimen comprised benzodiazepines in one-third of the patients and antidepressants in one-quarter. There was no statistically significant association between treatment regimen and the clinical and demographic variables studied, except for biological sex (female). The percentage of patients treated with LAIs in this study was almost three times higher than the rate previously reported in Greece and is higher than the rates reported in other countries. Patients with schizophrenia-spectrum disorders in rural Greece may have adequate access to innovative treatment with second-generation LAIs. Further research is needed to demonstrate the cost-effectiveness of LAI treatment in rural communities and to elucidate the factors associated with such treatment.
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Drosos P, Johnsen E, Bartz-Johannessen CA, Larsen TK, Reitan SK, Rettenbacher M, Kroken RA. Trajectories of response in schizophrenia-spectrum disorders: A one-year prospective cohort study of antipsychotic effectiveness. World J Psychiatry 2022; 12:521-532. [PMID: 35433321 PMCID: PMC8968498 DOI: 10.5498/wjp.v12.i3.521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/14/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment; however, their effectiveness has been questioned, and it is not possible to predict the response to a specific antipsychotic drug in an individual patient. Thus, it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.
AIM To investigate the effectiveness of antipsychotic drugs, we examined response trajectories and predictors for belonging to different trajectory groups.
METHODS The Bergen-Stavanger-Innsbruck-Trondheim (BeSt InTro) trial compared the effectiveness of three atypical antipsychotics-amisulpride, aripiprazole, and olanzapine-in a prospective, semirandomized, rater-blind, head-to-head design. Adult participants with a schizophrenia spectrum disorder diagnosis, according to international classification of diseases, Tenth Revision (ICD-10) F20–29, were included. Participants were followed for a period of 12 mo, with assessments at baseline; after one, three and six weeks; and after three, six, nine and 12 mo. A latent class mixed model was fitted to our data. The three-trajectory model based on the Positive and Negative Syndrome Scale (PANSS) total score reduction was found to have adequate fit, and the study drugs, as well as various demographic and clinical parameters, were tested as predictors for belonging to the different trajectory groups.
RESULTS Overall, 144 participants were included, and 41% completed the 12-mo study period. The largest trajectory group, consisting of 74% of participants, showed a PANSS total score reduction of 59% from baseline to 12 mo (Good response group). A trajectory group comprising 13% of participants had their PANSS total score reduced by 82.5% at 12 mo (Strong response group), while the last response trajectory group comprising 13% of the participants had a PANSS total score reduction of 13.6% (Slight response group). The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment, amounting to 45% and 48% reductions from baseline, respectively. The use of amisulpride predicted belonging to the Strong response group, while unemployment, depression, and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group, indicating a poor response to antipsychotic drug treatment.
CONCLUSION Most of the participants (87%) had a good outcome after one year. Amisulpride users, more often than aripiprazole and olanzapine users, belonged to the response trajectory group with a strong response.
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Affiliation(s)
- Petros Drosos
- TIPS-Network for Clinical Research in Psychosis, Clinic For Adult Mental Health, Stavanger University Hospital, Stavanger 4011, Norway
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
| | - Erik Johnsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
| | | | - Tor Ketil Larsen
- TIPS-Network for Clinical Research in Psychosis, Clinic For Adult Mental Health, Stavanger University Hospital, Stavanger 4011, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
| | - Solveig Klæbo Reitan
- Institute for Mental Health, St Olav's University Hospital, Trondheim 7030, Norway
- Department of Mental Health, Norwegian University of Natural Science and Technology, Trondheim 7491, Norway
| | - Maria Rettenbacher
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck 6020, Austria
| | - Rune Andreas Kroken
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen 5036, Norway
- Department of Clinical Medicine, University of Bergen, Bergen 5007, Norway
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Caqueo-Urízar A, Ferrer R, Ponce F, Urzúa A, Boyer L. Clinical outcomes of schizophrenia: A differential study among Latin-American countries. Psychiatry Res 2020; 292:113334. [PMID: 32768808 DOI: 10.1016/j.psychres.2020.113334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Rodrigo Ferrer
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica, Chile.
| | | | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile.
| | - Laurent Boyer
- Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille Univ, Marseille, France.
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Correll C, Cañas F, Larmo I, Levy P, Montes JM, Fagiolini A, Papageorgiou G, Rossi A, Sturlason R, Zink M. Individualizing antipsychotic treatment selection in schizophrenia: characteristics of empirically derived patient subgroups. Eur Psychiatry 2020; 26:3-16. [DOI: 10.1016/s0924-9338(11)71709-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractTreatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
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Abstract
AbstractPurposeTo characterise patients with schizophrenia from four European countries treated with ziprasidone, and to compare these with patients treated with other second generation antipsychotics (SGAs) included in this survey.MethodA randomly selected, representative sample of psychiatrists (N = 744), from Germany, Greece, Italy and Spain, collected data on the five last patients with schizophrenia they had seen in consultation (N = 3996), including up to two patients treated with ziprasidone (N = 1096).ResultsZiprasidone was most frequently prescribed to patients requiring a switch from another antipsychotic. Compared to other surveyed SGAs, ziprasisone was more likely to be prescribed to women than to men (OR: 1.52), to patients with mild disease than to those with severe disease (OR: 1.94) and to outpatients than to inpatients (1.30). The most frequently cited reasons for prescribing ziprasidone were good tolerability and efficacy against positive and negative symptoms. Compared to other SGAs included in this survey, it was more likely to be prescribed due to the low risk of weight gain, metabolic syndrome and extrapyramidal symptoms.ConclusionPatients treated by ziprasidone more frequently belong to subgroups composed of more autonomous patients and those with mild to moderate disease severity.
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Ran MS, Weng X, Liu YJ, Zhang TM, Yu YH, Peng MM, Luo W, Hu SH, Yang X, Liu B, Zhang T, Thornicroft G, Chan CLW, Xiang MZ. Changes in treatment status of patients with severe mental illness in rural China, 1994-2015. BJPsych Open 2019; 5:e31. [PMID: 31068242 PMCID: PMC6469230 DOI: 10.1192/bjo.2019.13] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.AimsTo explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI. METHOD Two mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China. RESULTS Compared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status. CONCLUSIONS Socioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.Declaration of interestNone.
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Affiliation(s)
- Mao-Sheng Ran
- Associate Professor,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Xue Weng
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Yu-Jun Liu
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Tian-Ming Zhang
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Yue-Hui Yu
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Man-Man Peng
- Researcher,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Wei Luo
- Doctor,Xinjin Mental Hospital,China
| | - Shi-Hui Hu
- Doctor,Chengdu Mental Health Center,China
| | - Xin Yang
- Doctor,Guangyuan Mental Health Center,China
| | - Bo Liu
- Professor,Jingzhou Mental Health Center,China
| | - Tin Zhang
- Doctor,Santai Mental Health Center,China
| | - Graham Thornicroft
- Professor,Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK
| | - Cecilia Lai-Wan Chan
- Professor,Department of Social Work and Social Administration,University of Hong Kong,China
| | - Meng-Ze Xiang
- Professor,Department of Psychiatry,West China Hospital, Sichuan University,China
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Nordon C, Bovagnet T, Belger M, Jimenez J, Olivares R, Chevrou-Severac H, Verdoux H, Haro JM, Abenhaim L, Karcher H. Trial exclusion criteria and their impact on the estimation of antipsychotic drugs effect: A case study using the SOHO database. Schizophr Res 2018; 193:146-153. [PMID: 28712965 DOI: 10.1016/j.schres.2017.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/05/2017] [Accepted: 07/09/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the impact upon estimation of drug effect as a result of applying exclusion criteria in randomized-controlled trials (RCT) measuring the efficacy of antipsychotics (AP) in schizophrenia. METHODS Three characteristics which may act as effect-modifiers of AP, while also common exclusion criteria in RCTs, were identified through literature review: schizophrenia duration, substance use disorder and poor adherence. The SOHO cohort was used to estimate the effect of initiating antipsychotic drugs "A", "B" or "C" (pooled) upon symptom evolution at 3months from baseline (CGI-S scale). "Estimated effectiveness" and "estimated efficacy" were drawn from the "SOHO" and "RCT-like" (patients with none of the above-listed exclusion criteria) samples, respectively. Effect-modification and impact of each exclusion criterion on AP effect estimates were explored using non-adjusted statistics. RESULTS The "SOHO sample" included 8250 patients initiating drug A, B or C at baseline, whose AP "estimated effectiveness" was ΔCGI-S=-0.78 (95% CI=-0.80, -0.76). The "RCT-like" sub-sample included 5348 (65%) patients whose AP "estimated efficacy" was ΔCGI-S=-0.73 (95% CI=-0.75, -0.70). Patients with short illness duration (≤3years since first AP; n=2436) experienced significant symptom improvement (ΔCGI-S=-0.89; 95%CI=-0.93, -0.85) compared to patients with duration >3years (mean ΔCGI-S=-0.73; 95%CI=-0.76, -0.71). Excluding patients with short illness duration led to a change in AP effect estimates but this was not the case for substance use disorder or poor adherence. CONCLUSION Using certain exclusion criteria in RCTs may impact the drug's effect estimate, particularly when exclusion criteria are AP effect-modifiers representing frequent characteristics among patients with schizophrenia.
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Affiliation(s)
| | | | - Mark Belger
- Lilly Research Centre, Eli Lilly and Company Limited, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, United Kingdom
| | - Javier Jimenez
- Medical Evidence and Observational Research, AstraZeneca, 1 Medimmune way, Gaithersburg, MD, United States
| | - Robert Olivares
- Global HEOR, Sanofi, 1 Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Helene Chevrou-Severac
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152 Glattpark-Opfikon, Zurich, Switzerland
| | - Helene Verdoux
- Univ. Bordeaux 2 and INSERM U1219, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
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Clerici M, de Bartolomeis A, De Filippis S, Ducci G, Maremmani I, Martinotti G, Schifano F. Patterns of Management of Patients With Dual Disorder (Psychosis) in Italy: A Survey of Psychiatrists and Other Physicians Focusing on Clinical Practice. Front Psychiatry 2018; 9:575. [PMID: 30483161 PMCID: PMC6243108 DOI: 10.3389/fpsyt.2018.00575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/19/2018] [Indexed: 12/18/2022] Open
Abstract
Patients with severe psychotic disorders such as schizophrenia, schizoaffective, and bipolar disorders frequently suffer from concomitant substance use disorders (SUDs)-Dual Disorder (DD) patients. In order to better understand current practices for management of patients with psychotic episodes and concomitant SUD in Italy, we carried out a survey of psychiatrists on current routine practice among prescribers. These aspects can help to identify at-risk patients, improve current prescribing practices, and favor early intervention. An ad hoc survey of 17 questions was administered to psychiatrists via electronic polling and on-line distribution; 448 completed questionnaires were collected. Comorbid substance abuse was most frequently diagnosed within the context of anxiety disorder (46%), followed by bipolar disorder (25%), and schizophrenia/schizoaffective disorder (12%). The vast majority of respondents felt that patient management was becoming more complex due to substance abuse. The areas reported to be most affected in patients with SUD were functioning, interpersonal relations, and impulsivity, while sensory perception disorders, ideation, agitation, and impulsivity were the most frequently reported symptoms. In the acute setting, haloperidol was used as the first-line agent of choice followed by aripiprazole and olanzapine. In the maintenance phase, aripiprazole was the dominantly used first-line agent, followed by olanzapine. Almost half of respondents used long-acting agents, while about one-third did not. Among those prescribing long-acting agents, efficacy, control of impulsivity, and control of specific symptoms were cited as motivators, while in the maintenance phase, better adherence, and tolerability were mainly cited. From the responses to the present survey, it is clear that the respondents are aware of the problem of SUD in psychotic patients. While treatment be optimized in terms of the choice and formulation of antipsychotics, greater emphasis should be placed on efficacy, tolerability, and the negative metabolic consequences of some antipsychotics. When considering the ideal antipsychotic, long-acting agents were considered to be superior in reducing relapse, even if current treatment guidelines often give preference to oral formulations.
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Affiliation(s)
- Massimo Clerici
- School of Medicine and Surgery-University of Milano Bicocca, Milan, Italy.,Psychiatric Department, Azienda Socio Sanitaria Territoriale (ASST) di Monza, Monza, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Sergio De Filippis
- Department of Neuropsychiatry, Villa von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Giuseppe Ducci
- Mental Health Department, Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Pisa, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, University "G.d'Annunzio" Chieti-Pescara, Chieti, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Nicotra E, Casu G, Piras S, Marchese G. On the use of the Positive and Negative Syndrome Scale in randomized clinical trials. Schizophr Res 2015; 165:181-7. [PMID: 25937460 DOI: 10.1016/j.schres.2015.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 11/16/2022]
Abstract
In the last 25 years, the Positive and Negative Syndrome Scale (PANSS) has been largely used to assess schizophrenia symptom intensity, but little information is available on how this scale was generally applied when evaluating the efficacy of schizophrenia therapies in randomized clinical trials. In the attempt to address this topic, a systematic PubMed Search was carried out using the keywords "PANSS" and "Randomized Clinical Trials". The analysis of retrieved articles highlighted that PANSS has constituted a suitable psychometric instrument to investigate the efficacy of pharmacological and non-pharmacological therapies. However, the information potentially provided by this scale was only partially reported in research articles, when characterizing the symptomatic features of patients at baseline. Furthermore, a consensus is needed to identify methodological strategies that may properly adapt PANSS-subscale structure with the symptomatic profiles of individuals enrolled in randomized controlled trials. The possibility that PANSS interview procedures and enrollment eligibility criteria may influence the symptomatic composition of patients involved in these studies is also discussed.
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Affiliation(s)
- Eraldo Nicotra
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Bld. 1, Is Mirrionis Str., I-09123 Cagliari, Italy
| | - Gianluca Casu
- National Research Council, Institute of Translational Pharmacology, UOS of Cagliari, Bld. 5, Loc. Piscinamanna, POLARIS, I-09010 Pula, Cagliari, Italy
| | - Sara Piras
- National Research Council, Institute of Translational Pharmacology, UOS of Cagliari, Bld. 5, Loc. Piscinamanna, POLARIS, I-09010 Pula, Cagliari, Italy
| | - Giorgio Marchese
- National Research Council, Institute of Translational Pharmacology, UOS of Cagliari, Bld. 5, Loc. Piscinamanna, POLARIS, I-09010 Pula, Cagliari, Italy.
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Citrome L, Eramo A, Francois C, Duffy R, Legacy SN, Offord SJ, Krasa HB, Johnston SS, Guiraud-Diawara A, Kamat SA, Rohman P. Lack of tolerable treatment options for patients with schizophrenia. Neuropsychiatr Dis Treat 2015; 11:3095-104. [PMID: 26719694 PMCID: PMC4689285 DOI: 10.2147/ndt.s91917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. PATIENTS AND METHODS AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. RESULTS A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined. CONCLUSION When combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | | | | | - Ruth Duffy
- Otsuka America Pharmaceuticals, Princeton, NJ, USA
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Mohr P, Rodriguez M, Bravermanová A, Melicher T, Čeplová Z, Čermák J, Pečeňák J. Social and functional capacity of schizophrenia patients: A cross-sectional study. Int J Soc Psychiatry 2014; 60:352-8. [PMID: 23775144 DOI: 10.1177/0020764013489673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The chronic course of schizophrenia typically results in severe social, vocational and functional impairment, interferes with patients' autonomy, reduces quality of life and increases disability. AIMS The aim of our study was: (1) to assess social and functional impairment in schizophrenia outpatients from the Czech Republic and Slovakia; and (2) to examine a relationship between functioning and antipsychotic treatment and demographic variables. METHODS Schizophrenia outpatients in a stable phase of illness, treated with current antipsychotic medication for a minimum of one month, were enrolled for the study. Demographic and medication data were recorded. The Personal and Social Performance (PSP), Subjective Well-Being under Neuroleptics (SWN) and Clinical Global Impressions (CGI) scales were administered. RESULTS The total number of study subjects was 926. Most PSP values were within the interval of moderate impairment. Functional performance correlated positively with subjective satisfaction with medication and negatively with symptom severity. Higher education predicted better functioning on PSP. The best performance was associated with a stable relationship and a useful work role. Patients who showed the best level of functioning were more likely to be treated with antipsychotic monotherapy. No difference among drugs in monotherapy was found in subjective satisfaction. CONCLUSIONS The PSP values of stable schizophrenia outpatients indicated a moderate degree of impairment. Improvement of functional capacity remains one of the unmet needs of schizophrenia patients.
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Affiliation(s)
- Pavel Mohr
- Prague Psychiatric Centre, Czech Republic, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Anna Bravermanová
- Prague Psychiatric Centre, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Melicher
- Prague Psychiatric Centre, Czech Republic, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Jan Čermák
- Prague Psychiatric Centre, Czech Republic, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Ján Pečeňák
- Psychiatric Clinic, University Hospital Bratislava, Slovakia, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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Buoli M, Dell'osso B, Zaytseva Y, Gurovich IY, Movina L, Dorodnova A, Shmuckler A, Altamura AC. Duration of untreated illness (DUI) and schizophrenia sub-types: a collaborative study between the universities of Milan and Moscow. Int J Soc Psychiatry 2013; 59:765-70. [PMID: 23034286 DOI: 10.1177/0020764012456807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies show an association between a long duration of untreated illness (DUI) and poor outcome in schizophrenic patients. DUI, in turn, may be influenced by different variables including specific illness-related factors as well as access to local psychiatric services. AIMS The purposes of the present study were to detect differences in terms of DUI among schizophrenics coming from different geographic areas and to evaluate differences in DUI across diagnostic sub-types. METHOD One hundred and twenty-five (125) schizophrenic patients of the Psychiatric Clinic of Milan (n = 51) and Moscow (n = 74) were enrolled. SCID-I was administered to all patients and information about DUI was obtained by consulting clinical charts and health system databases, and by means of clinical interviews with patients and their relatives. DUI was defined as the time between the onset of illness and the administration of the first antipsychotic drug. One-way analyses of variance (ANOVAs) were performed to find eventual differences in terms of DUI across diagnostic sub-types. RESULTS Italian patients showed a longer DUI (M = 4.14 years, SD = 4.95) than Russians (M = 1.16 years, SD = 1.43) (F = 24.03, p < .001). DUI was found to be longer in paranoid schizophrenics (M = 3.47 years, SD = 4.19) compared to catatonic patients (M = 0.96 years, SD = 0.94) (F = 3.56, p = .016). CONCLUSIONS The results of the present study suggest that the different schizophrenic sub-types may differ in terms of DUI, likely due to different clinical severity and social functioning. Studies with larger samples are needed to confirm the data of the present study.
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Jukic V, Jakovljevic M, Filipcic I, Herceg M, Silic A, Tomljanovic T, Zilbershtein R, Jensen RCD, Hemels MEH, Einarson TR. Cost-Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia. Value Health Reg Issues 2013; 2:181-188. [PMID: 29702863 DOI: 10.1016/j.vhri.2013.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES As a nation with a developing economy, Croatia is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. We conducted a pharmacoeconomic analysis to determine the cost-effectiveness of atypical depots in Croatia. METHODS A 1-year decision-analytic framework modeled drug use. We determined the average direct cost to the Croatian Institute for Health Insurance of using depot formulations of paliperidone palmitate long-acting injectable (PP-LAI), risperidone LAI (RIS-LAI), or olanzapine LAI (OLZ-LAI). An expert panel plus literature-derived clinical rates populated the core model, along with costs adjusted to 2012 by using the Croatian consumer price index. Clinical outcomes included quality-adjusted life-years, hospitalization rates, emergency room treatment rates, and relapse days. Robustness of results was examined with one-way sensitivity analyses on important inputs; overall, all inputs were varied over 10,000 simulations in a Monte Carlo analysis. RESULTS Costs (quality-adjusted life-years) per patient were €5061 (0.817) for PP-LAI, €5168 (0.807) for RIS-LAI, and €6410 (0.812) for OLZ-LAI. PP-LAI had the fewest relapse days, emergency room visits, and hospitalizations. Results were sensitive against RIS-LAI with respect to drug costs and adherence rates, but were generally robust overall, dominating OLZ-LAI in 77.3% and RIS-LAI in 56.8% of the simulations. CONCLUSIONS PP-LAI dominated the other drugs because it had the lowest cost and best clinical outcomes. Compared with depots of olanzapine and risperidone and oral olanzapine, PP-LAI was the cost-effective atypical LAI for treating chronic schizophrenia in Croatia. Using depot paliperidone in place of either olanzapine or risperidone would reduce the overall costs of caring for these patients.
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Affiliation(s)
- Vlado Jukic
- University Psychiatric Hospital "Vrapce," Zagreb, Croatia
| | - Miro Jakovljevic
- Department of Psychiatry, University Hospital of Zagreb, Zagreb, Croatia
| | - Igor Filipcic
- Department of Psychiatry, University Hospital of Zagreb, Zagreb, Croatia
| | | | - Ante Silic
- University Psychiatric Hospital "Sv Ivan," Zagreb, Croatia
| | | | | | | | | | - Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
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Einarson TR, Zilbershtein R, Skoupá J, Veselá S, Garg M, Hemels MEH. Economic and clinical comparison of atypical depot antipsychotic drugs for treatment of chronic schizophrenia in the Czech Republic. J Med Econ 2013; 16:1089-95. [PMID: 23808900 DOI: 10.3111/13696998.2013.820193] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The Czech Republic is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. A pharmacoeconomic analysis was conducted to determine the cost-effectiveness of atypical depots. METHODS An existing 1-year decision-analytic framework was adapted to model drug use in this healthcare system. The average direct costs to the General Insurance Company of the Czech Republic of using paliperidone palmitate (Xeplion®), risperidone (Risperdal Consta®), and olanzapine pamoate (Zypadhera®) were determined. Literature-derived clinical rates populated the model, with costs adjusted to 2012 Euros using the consumer price index. Outcomes included quality-adjusted life-years (QALYs), days in remission, and proportions hospitalized or visiting emergency rooms. One-way sensitivity analyses were calculated for all important inputs. A multivariate probability analysis was used to examine the stability of results using 10,000 iterations of simulated input over reasonable ranges of all included variables. RESULTS Expected average costs/per patient treated were €5377 for PP-LAI, €6118 for RIS-LAI, and €6537 for OLZ-LAI. Respective QALYs were 0.817, 0.809, and 0.811; ER visits were 0.127, 0.134, and 0.141; hospitalizations were 0.252, 0.298, and 0.289. Results were generally robust in sensitivity analyses. PP-LAI dominated RIS-LAI and OLZ-LAI in 90.2% and 92.1% of simulations, respectively. Results were insensitive to drug prices but sensitive to adherence and hospitalization rates. CONCLUSIONS PP-LAI dominated the other two drugs, as it had a lower overall cost and superior clinical outcomes, making it the preferred choice. Using PP-LAI in place of RIS-LAI for chronic relapsing schizophrenia would reduce the overall costs of care for the healthcare system.
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Gorwood P. Factors associated with hospitalisation of patients with schizophrenia in four European countries. Eur Psychiatry 2011; 26:224-30. [PMID: 21429717 DOI: 10.1016/j.eurpsy.2011.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/15/2011] [Accepted: 02/20/2011] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To analyse factors associated with hospitalisation in patients with schizophrenia from four European countries, and to investigate whether national specificities might have an impact on the profile of inpatients. METHOD A randomly selected sample of psychiatrists (N = 744), from Germany, Greece, Italy and Spain, collected data on the five last patients with schizophrenia they had seen in consultation (N = 3996). RESULTS High positive symptoms, lack of insight, not living with the family, frequent past episodes, addiction to illegal drugs, global severity, uncooperativeness and smoking were significantly associated with hospitalisation, with OR between 4.1 and 1.26. Nevertheless, only high positive symptoms from the PANSS and lack of insight were systematically detected in the four countries. Among different results, the weight of "not living with the family" had national specificities, as Germany was the only country where this factor played no role (OR = 0.94). CONCLUSION Although some factors such as positive symptoms are associated with hospitalisation in a very homogenous way throughout different countries, discrepancies were detected between countries, for "living with the family", "number of past acute relapses" and "uncooperativeness". Linking these specificities to national healthcare systems might be useful to promote access to care for all patients.
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Affiliation(s)
- P Gorwood
- CMME, Sainte-Anne Hospital, University Paris Descartes, 100, rue de la Santé, 75674 Paris cedex 14, France.
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