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Piacentino D, Ogirala A, Lew R, Loftus G, Worden M, Koblan KS, Hopkins SC. A Novel Method for Deriving Adverse Event Prevalence in Randomized Controlled Trials: Potential for Improved Understanding of Benefit-Risk Ratio and Application to Drug Labels. Adv Ther 2024; 41:152-169. [PMID: 37855974 PMCID: PMC10796692 DOI: 10.1007/s12325-023-02695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Adverse event (AE) data in randomized controlled trials (RCTs) allow quantification of a drug's safety risk relative to placebo and comparison across medications. The standard US label for Food and Drug Administration-approved drugs typically lists AEs by MedDRA Preferred Term that occur at ≥ 2% in drug and with greater incidence than in placebo. We suggest that the drug label can be more informative for both patients and physicians if it includes, in addition to AE incidence (percent of subjects who reported the AE out of the total subjects in treatment), the absolute prevalence (percent of subject-days spent with an AE out of the total subject-days spent in treatment) and expected duration (days required for AE incidence to be reduced by half). We also propose a new method to analyze AEs in RCTs using drug-placebo difference in AE prevalence to improve safety signal detection. METHODS AE data from six RCTs in schizophrenia were analyzed (five RCTs of the dopamine D2 receptor-based antipsychotic lurasidone and one RCT of the novel trace amine-associated receptor 1 [TAAR1] agonist ulotaront). We determined incidence, absolute prevalence, and expected duration of AEs for lurasidone and ulotaront vs respective placebo. We also calculated areas under the curve of drug-placebo difference in AE prevalence and mean percent contribution of each AE to this difference. RESULTS A number of AEs with the same incidence had different absolute prevalence and expected duration. When accounting for these two parameters, AEs that did not appear in the 2% incidence tables of the drug label turned out to contribute substantially to drug tolerability. The percent contribution of a drug-related AE to the overall side effect burden increased the drug-placebo difference in AE prevalence, whereas the percent contribution of a placebo-related AE decreased such difference, revealing a continuum of risk between drug and placebo. AE prevalence curves for drug were generally greater than those for placebo. Ulotaront exhibited a small drug-placebo difference in AE prevalence curves due to a relatively low incidence and short duration of AEs in the ulotaront treatment arm as well as the emergence of disease-related AEs in the placebo arm. CONCLUSION Reporting AE absolute prevalence and expected duration for each RCT and incorporating them in the drug label is possible, is clinically relevant, and allows standardized comparison of medications. Our new metric, the drug-placebo difference in AE prevalence, facilitates signal detection in RCTs. We piloted this metric in RCTs of several neuropsychiatric indications and drugs, offering a new way to compare AE burden and tolerability among treatments using existing clinical trial information.
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Affiliation(s)
- Daria Piacentino
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Ajay Ogirala
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Robert Lew
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Gregory Loftus
- Sumitomo Pharma America, Inc. (Formerly Sumitovant Biopharma Inc.), Marlborough, MA, USA
| | - MaryAlice Worden
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Kenneth S Koblan
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA
| | - Seth C Hopkins
- Sumitomo Pharma America, Inc. (Formerly Sunovion Pharmaceuticals, Inc.), 84 Waterford Drive, Marlborough, MA, 01752, USA.
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Rodolico A, Concerto C, Ciancio A, Siafis S, Fusar-Poli L, Romano CB, Scavo EV, Petralia A, Salomone S, Signorelli MS, Leucht S, Aguglia E. Validation of the Glasgow Antipsychotic Side-Effect Scale (GASS) in an Italian Sample of Patients with Stable Schizophrenia and Bipolar Spectrum Disorders. Brain Sci 2022; 12:brainsci12070891. [PMID: 35884698 PMCID: PMC9313430 DOI: 10.3390/brainsci12070891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Antipsychotics are a class of psychotropic drugs that improve psychotic symptoms and reduce relapse risk. However, they may cause side effects (SE) that impact patients’ quality of life and psychosocial functioning. Therefore, there is a need for practical tools to identify them and possibly intervene. The objective of the present study was to translate into Italian the Glasgow Antipsychotic Side Effect Scale (GASS), which is suggested as the questionnaire of choice to collect SE reported by patients treated with antipsychotics. We administered the GASS and the Udvalg for Kliniske Undersøgelser (UKU) SE scale—which is considered the gold standard—to 100 stable patients with schizophrenia and bipolar spectrum disorders. We measured the structural validity, internal consistency, concurrent criterion validity, construct validity, and clinical feasibility. GASS was characterized by modest structural validity and good internal consistency. The binary correlations concerning the presence of specific symptoms investigated with the GASS and the UKU were strong or relatively strong for only half of them. The GASS total scale score was inversely related to patients’ quality of life and psychosocial functioning. The GASS is useful to briefly assess the burden of antipsychotic SE (~5 min) but is not optimal in identifying them.
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Affiliation(s)
- Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
- Correspondence:
| | - Carmen Concerto
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Alessia Ciancio
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.S.); (S.L.)
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Carla Benedicta Romano
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Elisa Vita Scavo
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Antonino Petralia
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Salvatore Salomone
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 94123 Catania, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (S.S.); (S.L.)
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (C.C.); (A.C.); (L.F.-P.); (C.B.R.); (E.V.S.); (A.P.); (M.S.S.); (E.A.)
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Wei YY, Lin WF, Zhang TH, Tang YX, Wang JJ, Zhong MF. Effectiveness of Traditional Chinese Medicineas as an Adjunct Therapy for Refractory Schizophrenia: A Systematic Review and Meta Analysis. Sci Rep 2018; 8:6230. [PMID: 29670200 PMCID: PMC5906629 DOI: 10.1038/s41598-018-24547-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/04/2018] [Indexed: 11/08/2022] Open
Abstract
Although recent studies focused on traditional Chinese medicine (TCM) for the treatment of refractory schizophrenia have reported that it may be beneficial, there is still lack of convincing evidence and critical meta-analytic work regarding its effectiveness as an adjunctive therapy. Therefore, we performed a meta-analysis to investigate the effectiveness of TCM in combination with antipsychotics for refractory schizophrenia. Fourteen articles involving 1725 patients published as of December 2016 were included which compared antipsychotic therapies to either TCM alone, or TCM as an adjunctive therapy. TCM was observed to have beneficial effects on aspects of the Positive and Negative Syndrome Scale (PANSS) including total score changes and negative score changes, as well as clinical effects estimated with PANSS or the Brief Psychiatric Rating Scale (BPRS). The changes in extrapyramidal side effects (RSESE) scores from baseline to the end of the treatment period were similar in two groups of related trials. TCM was also reported to mitigate some anti-psychotic related side-effects and overall, TCM adjuvant therapy was generally safe and well tolerated. While, the results indicated the potential utility of TCM as an alternative adjunctive therapeutic for refractory schizophrenia treatment, there remains a need for further high-quality studies.
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Affiliation(s)
- Yan-Yan Wei
- Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Wan-Fu Lin
- Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Tian-Hong Zhang
- Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Yun-Xiang Tang
- Department of medical psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Ji-Jun Wang
- Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China.
| | - Mao-Feng Zhong
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, P.R. China.
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Iversen TSJ, Steen NE, Dieset I, Hope S, Mørch R, Gardsjord ES, Jørgensen KN, Melle I, Andreassen OA, Molden E, Jönsson EG. Side effect burden of antipsychotic drugs in real life - Impact of gender and polypharmacy. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:263-271. [PMID: 29122637 DOI: 10.1016/j.pnpbp.2017.11.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Antipsychotic-associated side effects are well known and represent a significant treatment challenge. Still, few large studies have investigated the overall side effect burden of antipsychotics in real-life settings. OBJECTIVE To describe the occurrence of side effects and perceived burden of antipsychotics in a large naturalistic sample, taking polypharmacy and patient characteristics into account. METHOD Patients (n=1087) with psychotic disorders were assessed for side effects using the Udvalg for Kliniske Undersøgelser (UKU) side effect rating scale in addition to assessment of clinical and pharmacological data. Statistical analyses were performed controlling for possible confounding factors. RESULTS Use of antipsychotics showed significant associations to neurologic and sexual symptoms, sedation and weight gain, and >75% of antipsychotics-users reported side effects. More side effects were observed in patients using several antipsychotics (p=0.002), with increasing total dose (p=0.021) and with antipsychotics in combinations with other psychotropic drugs. Patients and investigators evaluated the side effect burden differently, particularly related to severity, gender and antipsychotics dose. Twice as many females described side effect burden as severe (p=0.004). CONCLUSION Patients with psychotic disorders have a high occurrence of symptoms associated with use of antipsychotics, and polypharmacy and female gender are seemingly risk factors for reporting a severe side effect burden. Due to the cross-sectional design evaluation of causality is tentative, and these findings should be further investigated in prospective studies.
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Affiliation(s)
- Trude Seselie Jahr Iversen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.
| | - Nils Eiel Steen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ingrid Dieset
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Sigrun Hope
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Ragni Mørch
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Erlend Strand Gardsjord
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
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