1
|
Alansary AM, Elbeialy MAK. Impact of Preoperative Aripiprazole on Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Double-blind Placebo-controlled Trial. Clin J Pain 2024; 40:341-348. [PMID: 38450551 DOI: 10.1097/ajp.0000000000001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Aripiprazole is a second-generation atypical antipsychotic with worldwide clinical approval. Nevertheless, its perioperative antinociceptive application has not been studied. As a result, the purpose of this study was to investigate the analgesic effects of perioperative aripiprazole on reducing postoperative pain, as well as the possible adverse effects. PATIENTS AND METHODS This randomized controlled study enrolled 80 female patients scheduled for laparoscopic hysterectomy who were assigned randomly into 2 equal groups in 1:1; aripiprazole group (n = 40), patients received an aripiprazole 30 mg tablet orally 3 hours before surgery and placebo group (n = 40), patients received a placebo tablet 3 hours before surgery. The 24-hour morphine consumption postoperatively was the primary outcome, and the time to the first analgesic request, sedation scores, and the incidence of perioperative adverse events were the secondary outcomes. RESULTS The mean 24-hour morphine consumption was significantly lower with aripiprazole (2.5 ± 0.5 mg) than with placebo (23.7 ± 1.6 mg; mean ± SE -21.2 ± 0.3, 95% CI: -21.7 to -20.6, P < 0.001). In addition, the mean time to the first analgesic request was significantly longer with aripiprazole (212.2 ± 14.7 min) than with placebo (27.0 ± 2.0 min; mean ± SE 185.2 ± 2.3, 95% CI: 180.5 to 189.8, P < 0.001). Furthermore, the aripiprazole group reported higher sedation scores ( P < 0.001). Bradycardia and hypotension were reported more frequently among patients in the aripiprazole group ( P < 0.05). CONCLUSION Aripiprazole was effective in reducing pain after laparoscopic hysterectomy. Although self-limited, side effects should be taken into consideration when using the medication perioperatively.
Collapse
Affiliation(s)
- Amin Mohamed Alansary
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | |
Collapse
|
2
|
Jiang Q, Li T, Zhao L, Sun Y, Mao Z, Xing Y, Wang C, Bo Q. Treatment of antipsychotic-induced hyperprolactinemia: an umbrella review of systematic reviews and meta-analyses. Front Psychiatry 2024; 15:1337274. [PMID: 38505795 PMCID: PMC10948402 DOI: 10.3389/fpsyt.2024.1337274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Background Hyperprolactinemia is a common antipsychotic-induced adverse event in psychiatric patients, and the quality of clinical studies investigating the best treatments has varied. Thus, to better summarize the clinical evidence, we performed an umbrella review of overlapping systematic reviews and meta-analyses for the treatment of antipsychotic-induced hyperprolactinemia. Methods The PubMed, Cochrane Library, PsycINFO, Scopus and EMBASE were searched, and reviews and meta-analyses meeting our inclusion criteria were selected. Relevant data were extracted, and an umbrella review was conducted of all included meta-analyses. The quality of included meta-analyses was assessed by using PRISMA scores and AMSTAR 2 quality evaluation. Finally, the clinical evidence for appropriate treatments was summarized and discussed. Results Five meta-analyses published between 2013 and 2020 met the requirements for inclusion in this umbrella review. The PRISMA scores of the included meta-analyses ranged from 19.5-26. AMSTAR 2 quality evaluation showed that 2 of the 5 included meta-analyses were of low quality and 3 were of very low quality. The included meta-analyses provide clinical evidence that adding aripiprazole or a dopamine agonist can effectively and safely improve antipsychotic-induced hyperprolactinemia. Two meta-analyses also showed that adjunctive metformin can reduce serum prolactin level, but more clinical trials are needed to confirm this finding. Conclusion Adjunctive dopamine agonists have been proven to be effective and safe for the treatment of antipsychotic-induced hyperprolactinemia. Among the researched treatments, adding aripiprazole may be the most appropriate.
Collapse
Affiliation(s)
- Qitong Jiang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Tian Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Zhao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yue Sun
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhen Mao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yujie Xing
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chuanyue Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qijing Bo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Khodaei M, Mehri S, Pour SR, Mahdavi S, Yarmohammadi F, Hayes AW, Karimi G. The protective effect of chemical and natural compounds against vincristine-induced peripheral neuropathy (VIPN). Naunyn Schmiedebergs Arch Pharmacol 2022; 395:907-919. [PMID: 35562512 DOI: 10.1007/s00210-022-02254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
Vincristine, an alkaloid extracted from Catharanthus rosea, is a class of chemotherapy drugs that act by altering the function of the microtubules and by inhibiting mitosis. Despite its widespread application, a major adverse effect of vincristine that limits treatment duration is the occurrence of peripheral neuropathy (PN). PN presents with several symptoms including numbness, painful sensation, tingling, and muscle weakness. Vincristine-induced PN involves impaired calcium homeostasis, an increase of reactive oxygen species (ROS), and the upregulation of tumor necrosis factor-alpha (TNF-α), and interleukin 1 beta (IL-1β) expression. Several potential approaches to attenuate the vincristine-induced PN including the concomitant administration of chemicals with vincristine have been reported. These chemicals have a variety of pharmaceutical properties including anti-inflammation, antioxidant, and inhibition of calcium channels and calcineurin signaling pathways and increased expression of nerve growth factor (NGF). This review summarized several of these compounds and the mechanisms of action that could lead to effective options in improving vincristine-induced peripheral neuropathy (VIPN).
Collapse
Affiliation(s)
- Mitra Khodaei
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soghra Mehri
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. .,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Soroush Rashid Pour
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shakiba Mahdavi
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Fatemeh Yarmohammadi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Wallace Hayes
- Center for Environmental Occupational Risk Analysis and Management, College of Public Health, University of South Florida, Tampa, FL, USA.,Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Gholamreza Karimi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. .,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
4
|
Mendes Ferreira RC, de Almeida DL, Duarte IDG, Aguiar DC, Moreira FA, Romero TRL. The antipsychotic aripiprazole induces peripheral antinociceptive effects through PI3Kγ/NO/cGMP/K
ATP
pathway activation. Eur J Pain 2022; 26:825-834. [DOI: 10.1002/ejp.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Igor Dimitri Gama Duarte
- Department of Pharmacology Institute of Biological Sciences Federal University of Minas Gerais Brazil
| | - Daniele Cristina Aguiar
- Department of Pharmacology Institute of Biological Sciences Federal University of Minas Gerais Brazil
| | - Fabrício Araújo Moreira
- Department of Pharmacology Institute of Biological Sciences Federal University of Minas Gerais Brazil
| | | |
Collapse
|
5
|
Raja Sekhara Reddy B, Pratap Reddy Gajulapalli V, Madhu Rekha E, Siva Krishna V, Sriram D, Sudakar Babu K, Kim E. Design, synthesis, and in vitro biological evaluation of dehydroaripiprazole derivatives as antituberculosis agents and molecular docking study. RESULTS IN CHEMISTRY 2022. [DOI: 10.1016/j.rechem.2022.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
6
|
Jin J, Zhang K, Dou F, Hao C, Zhang Y, Cao X, Gao L, Xiong J, Liu X, Liu BF, Zhang G, Chen Y. Isoquinolinone derivatives as potent CNS multi-receptor D2/5-HT1A/5-HT2A/5-HT6/5-HT7 agents: Synthesis and pharmacological evaluation. Eur J Med Chem 2020; 207:112709. [DOI: 10.1016/j.ejmech.2020.112709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022]
|
7
|
Madireddy S, Madireddy S. Regulation of Reactive Oxygen Species-Mediated Damage in the Pathogenesis of Schizophrenia. Brain Sci 2020; 10:brainsci10100742. [PMID: 33081261 PMCID: PMC7603028 DOI: 10.3390/brainsci10100742] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022] Open
Abstract
The biochemical integrity of the brain is paramount to the function of the central nervous system, and oxidative stress is a key contributor to cerebral biochemical impairment. Oxidative stress, which occurs when an imbalance arises between the production of reactive oxygen species (ROS) and the efficacy of the antioxidant defense mechanism, is believed to play a role in the pathophysiology of various brain disorders. One such disorder, schizophrenia, not only causes lifelong disability but also induces severe emotional distress; however, because of its onset in early adolescence or adulthood and its progressive development, consuming natural antioxidant products may help regulate the pathogenesis of schizophrenia. Therefore, elucidating the functions of ROS and dietary antioxidants in the pathogenesis of schizophrenia could help formulate improved therapeutic strategies for its prevention and treatment. This review focuses specifically on the roles of ROS and oxidative damage in the pathophysiology of schizophrenia, as well as the effects of nutrition, antipsychotic use, cognitive therapies, and quality of life on patients with schizophrenia. By improving our understanding of the effects of various nutrients on schizophrenia, it may become possible to develop nutritional strategies and supplements to treat the disorder, alleviate its symptoms, and facilitate long-term recovery.
Collapse
Affiliation(s)
- Samskruthi Madireddy
- Independent Researcher, 1353 Tanaka Drive, San Jose, CA 95131, USA
- Correspondence: ; Tel.: +1-408-9214162
| | - Sahithi Madireddy
- Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA;
| |
Collapse
|
8
|
Heo HJ, Park SY, Lee YS, Shin HK, Hong KW, Kim CD. Combination therapy with cilostazol, aripiprazole, and donepezil protects neuronal cells from β-amyloid neurotoxicity through synergistically enhanced SIRT1 expression. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2020; 24:299-310. [PMID: 32587124 PMCID: PMC7317180 DOI: 10.4196/kjpp.2020.24.4.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 01/13/2023]
Abstract
Alzheimer's disease (AD) is a multi-faceted neurodegenerative disease. Thus, current therapeutic strategies require multitarget-drug combinations to treat or prevent the disease. At the present time, single drugs have proven to be inadequate in terms of addressing the multifactorial pathology of AD, and multitarget-directed drug design has not been successful. Based on these points of views, it is judged that combinatorial drug therapies that target several pathogenic factors may offer more attractive therapeutic options. Thus, we explored that the combination therapy with lower doses of cilostazol and aripiprazole with add-on donepezil (CAD) might have potential in the pathogenesis of AD. In the present study, we found the superior efficacies of donepezil add-on with combinatorial mixture of cilostazol plus aripiprazole in modulation of expression of AD-relevant genes: Aβ accumulation, GSK-3β, P300, acetylated tau, phosphorylated-tau levels, and activation of α-secretase/ADAM 10 through SIRT1 activation in the N2a Swe cells expressing human APP Swedish mutation (N2a Swe cells). We also assessed that CAD synergistically raised acetylcholine release and choline acetyltransferase (CHAT) expression that were declined by increased β-amyloid level in the activated N2a Swe cells. Consequently, CAD treatment synergistically increased neurite elongation and improved cell viability through activations of PI3K, BDNF, β-catenin and a7-nicotinic cholinergic receptors in neuronal cells in the presence of Aβ1-42. This work endorses the possibility for efficient treatment of AD by supporting the synergistic therapeutic potential of donepezil add-on therapy in combination with lower doses of cilostazol and aripiprazole.
Collapse
Affiliation(s)
- Hye Jin Heo
- Department of Pharmacology, Pusan National University School of Medicine, Yangsan 50612, Korea.,Gene & Cell Therapy Research Center for Vessel-associated Diseases, Pusan National University, Yangsan 50612, Korea
| | - So Youn Park
- Department of Pharmacology, Pusan National University School of Medicine, Yangsan 50612, Korea.,Gene & Cell Therapy Research Center for Vessel-associated Diseases, Pusan National University, Yangsan 50612, Korea
| | - Yi Sle Lee
- Department of Pharmacology, Pusan National University School of Medicine, Yangsan 50612, Korea.,Gene & Cell Therapy Research Center for Vessel-associated Diseases, Pusan National University, Yangsan 50612, Korea
| | - Hwa Kyoung Shin
- Department of Korean Medical Science, Pusan National University School of Korean Medicine, Yangsan 50612, Korea
| | - Ki Whan Hong
- Gene & Cell Therapy Research Center for Vessel-associated Diseases, Pusan National University, Yangsan 50612, Korea
| | - Chi Dae Kim
- Department of Pharmacology, Pusan National University School of Medicine, Yangsan 50612, Korea.,Gene & Cell Therapy Research Center for Vessel-associated Diseases, Pusan National University, Yangsan 50612, Korea
| |
Collapse
|
9
|
Abstract
Aripiprazole, brexpiprazole and cariprazine differ from all other second-generation antipsychotics due to partial agonism at the dopamine D2 and D3 receptors. In contrast to aripiprazole, brexpiprazole has lower intrinsic dopamine D2 activity and higher affinity for the serotonin 5-HT1A and 5-HT2A receptors, while cariprazine has the highest affinity for the dopamine D3 receptor, and the longest half-life. The main adverse effect of dopamine receptor partial agonists (DRPAs) is akathisia of low-to-moderate severity, which occurs in a small proportion of patients, usually in the first few weeks of treatment. While definitive conclusions concerning differences between the DRPAs require head-to-head comparison studies, on the available evidence, akathisia is probably least likely to occur with brexpiprazole and most likely with cariprazine; the risk of akathisia with aripiprazole lies in between. Weight-gain risk is low with aripiprazole and cariprazine, but moderate with brexpiprazole. Risk of sedation is low with DRPAs, as is risk of insomnia and nausea. Partial dopamine agonism leads to a low risk for hyperprolactinaemia (and probably a low risk of sexual dysfunction). Prolactin concentrations fall in some patients (particularly those with elevated levels prior to initiating the drugs). Rates of discontinuation due to adverse effects in pivotal studies were low, and on the whole, DRPAs are well tolerated. Aripiprazole has been implicated in pathological gambling and other impulse control behaviours, likely due to partial dopamine agonist activity (there have been no reports with brexpiprazole and cariprazine). The risks for diabetes and tardive dyskinesia with DRPAs are unknown, but are likely to be low. On the basis of tolerability, DRPAs should be considered as first-line treatment options, particularly in patients with early schizophrenia.
Collapse
|
10
|
Najjar A, Najjar A, Karaman R. Newly Developed Prodrugs and Prodrugs in Development; an Insight of the Recent Years. Molecules 2020; 25:E884. [PMID: 32079289 PMCID: PMC7070911 DOI: 10.3390/molecules25040884] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The design and development of prodrugs is the most common and effective strategy to overcome pharmacokinetic and pharmacodynamic drawbacks of active drugs. A respected number of prodrugs have been reached the drugs market throughout history and the recent years have witnessed a significant increase in the use of prodrugs as a replacement of their parent drugs for an efficient treatment of various ailment. METHODS A Scan conducted to find recent approved prodrugs and prodrugs in development. RESULTS Selected prodrugs were reported and categorized in accordance to their target systems. CONCLUSIONS the prodrug approach has shown many successes and still remains a viable and effective approach to deliver new active agents. This conclusion is supported by the recent approved prodrugs and the scan of clinical trials conducted between 2013-2018.
Collapse
Affiliation(s)
- Anas Najjar
- Faculty of Pharmacy, Department of Bioorganic & Pharmaceutical Chemistry, Al-Quds University, Jerusalem P.O. Box 20002, Palestine;
| | - Abderrahman Najjar
- Institute of Pathology, Rabin Medical Centre, PetachTikva 49100, Israel;
| | - Rafik Karaman
- Faculty of Pharmacy, Department of Bioorganic & Pharmaceutical Chemistry, Al-Quds University, Jerusalem P.O. Box 20002, Palestine;
| |
Collapse
|
11
|
Abstract
OBJECTIVE Safety and tolerability of long-term treatment with the long-acting antipsychotic aripiprazole lauroxil (AL) were evaluated in patients with schizophrenia. METHODS This was an international, multicenter, phase 3, 52-week safety study of 2 fixed doses of AL (441 mg or 882 mg intramuscular every 4 weeks). Safety endpoints included adverse events (AEs) and extrapyramidal symptoms (EPS) including akathisia, injection-site reactions (ISRs), and clinically relevant changes in metabolic and endocrine values. RESULTS Of 478 patients entering this study, 236 (49%) continued from a previous 12-week, phase 3 efficacy study of AL, and 242 (51%) were newly enrolled. Overall, 77% and 23% of patients received AL 882 mg (N = 368) and 441 mg (N = 110), respectively. AEs occurred in 50.4% of patients; most were mild (28.7%) or moderate (18.2%). The most common AEs were insomnia (8.4%) and increased weight (5.0%). Akathisia was reported as an AE in 3.8% of the overall population, with higher rates in patients initiating AL on study entry than those continuing on AL. EPS-related AEs occurred in 9.4% of patients, and AEs related to metabolic parameters were reported in 4.6% of patients. Weight gain was minimal (0.8 kg), and no clinically relevant changes were observed for metabolic parameters. The overall incidence of ISRs was 3.8%; most were associated with the initial injections in patients receiving their first injection in this study. CONCLUSION Long-term treatment with AL is generally well tolerated, with a safety profile consistent with that of oral aripiprazole. It is a suitable option for patients with schizophrenia.
Collapse
|
12
|
Abstract
Brexpiprazole (Rxulti®, Rexulti®) is an oral atypical antipsychotic agent approved for the treatment of schizophrenia in the EU (in adult patients) and the USA, as well as in some other countries, including Japan. Like aripiprazole, it is a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2A receptors. However, brexpiprazole displays less intrinsic activity at D2 receptors and, coupled with actions at 5HT1A, 5HT2A and noradrenaline α1B receptors that are at least as potent as its action at D2 receptors, is predicted to demonstrate a lower propensity for activating adverse events and extrapyramidal symptoms than aripiprazole. Brexpiprazole 2-4 mg/day produced statistically significant and clinically meaningful improvements in overall symptomatology and psychosocial functioning compared with placebo in adults with acute exacerbation of schizophrenia. As maintenance treatment, brexpiprazole 1-4 mg/day significantly delayed the time to relapse compared with placebo in patients who were already stabilized on the drug and was associated with stabilization or continued improvement in patients' symptoms and functioning. Brexpiprazole was generally well tolerated, exhibiting an adverse event profile characterized by a relatively low incidence of activating and sedating adverse effects, small changes in QT interval and metabolic parameters that were not clinically significant, and moderate weight gain. Clinical evidence to date suggests it usefully extends the range of therapeutic options for schizophrenia.
Collapse
Affiliation(s)
- James E Frampton
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| |
Collapse
|
13
|
Montastruc F, Nie R, Loo S, Rej S, Dell’Aniello S, Micallef J, Suissa S, Renoux C. Association of Aripiprazole With the Risk for Psychiatric Hospitalization, Self-harm, or Suicide. JAMA Psychiatry 2019; 76:409-417. [PMID: 30698607 PMCID: PMC6450289 DOI: 10.1001/jamapsychiatry.2018.4149] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Some reports have raised concerns regarding a potential psychiatric worsening associated with first-time use of aripiprazole in patients already treated with other antipsychotic medications. Whether aripiprazole use, particularly in the long term, increases the risk for serious psychiatric events is unclear. OBJECTIVE To assess whether switching to or adding aripiprazole is associated with serious psychiatric treatment failure compared with switching to or adding another antipsychotic drug in patients previously exposed to antipsychotic medications. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted from January 1, 2005, to March 31, 2015. Data were obtained from the United Kingdom Clinical Practice Research Datalink, one of the world's largest computerized databases linked to the Hospital Episodes Statistics repository and the Office for National Statistics (ONS) mortality database. Within a base cohort of new users of antipsychotic drugs, patients switching or adding aripiprazole (n = 1643) were propensity matched 1:1 to patients switching to or adding another antipsychotic medication (n = 1643). All patients were followed up until psychiatric treatment failure, for 365 days (1 year) after cohort entry, until death from any cause other than suicide, until end of registration or linkage with the databases, or end of the study period (March 31, 2016). MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs of serious events of psychiatric treatment failure (psychiatric hospitalizations, self-harm, or suicide) associated with switching to or adding aripiprazole compared with other antipsychotic drugs. In addition to propensity score matching, all models were adjusted for age, number of psychiatric hospitalizations or self-harm events in the 6 months before cohort entry, number of different antipsychotic drugs before cohort entry, and quintiles of the Index of Multiple Deprivation. RESULTS The study cohort included 1643 patients (949 [57.8%] were women with a mean [SD] age of 42.1 [16.8] years) starting aripiprazole use; they were matched 1:1 to 1643 patients (871 [53.0%] were women with a mean [SD] age of 42.4 [17.1] years) starting use of another antipsychotic drug. During 2692 person-years of follow-up, 391 incident serious psychiatric treatment failures occurred, with a crude incidence rate of 14.52 (95% CI, 13.16-16.04) per 100 person-years. First-time use of aripiprazole was not associated with an increased rate of psychiatric treatment failure (HR, 0.87; 95% CI, 0.71-1.06), psychiatric hospitalizations (HR, 0.85; 95% CI, 0.69-1.06), or self-harm or suicide (HR, 0.96; 95% CI, 0.68-1.36) compared with starting use of another antipsychotic drug. Results were consistent across several sensitivity analyses. CONCLUSIONS AND RELEVANCE Initiating aripiprazole use, compared with another antipsychotic medication, after a previous antipsychotic exposure did not appear to be associated with psychiatric hospitalization, self-harm, or suicide; these findings warrant replication in large observational studies.
Collapse
Affiliation(s)
- François Montastruc
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada,Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Faculté de Médecine, Toulouse, France,Unité clinique de Pharmacologie psychiatrique, Faculté de Médecine, Centre Hospitalier Universitaire, Toulouse, France
| | - Rui Nie
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Simone Loo
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Sophie Dell’Aniello
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Joëlle Micallef
- Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada,Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| |
Collapse
|
14
|
Najjar A, Karaman R. Successes, failures, and future prospects of prodrugs and their clinical impact. Expert Opin Drug Discov 2019; 14:199-220. [DOI: 10.1080/17460441.2019.1567487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anas Najjar
- Department of Bioorganic & Pharmaceutical Chemistry, Faculty of Pharmacy, Al-Quds University, Jerusalem, Palestine
| | - Rafik Karaman
- Department of Bioorganic & Pharmaceutical Chemistry, Faculty of Pharmacy, Al-Quds University, Jerusalem, Palestine
| |
Collapse
|
15
|
Arabiani MR, Lodagekar A, Yadav B, Chavan RB, Shastri NR, Purohit PY, Shelat P, Dave D. Mechanochemical synthesis of brexpiprazole cocrystals to improve its pharmaceutical attributes. CrystEngComm 2019. [DOI: 10.1039/c8ce01689e] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the present study, cocrystallization of a new piprazole analogue drug, brexpiprazole (BREX), with coformers such as succinic acid and catechol was carried out using ball milling to address the poor solubility and dissolution rate of the molecule.
Collapse
Affiliation(s)
- Mohsin R. Arabiani
- Global IP
- Amneal Pharmaceuticals Pvt. Ltd
- Ahmedabad–380015
- India
- Kadi Sarva Vishwavidyalaya
| | - Anurag Lodagekar
- Solid State Pharmaceutical Research Group (SSPRG)
- Department of Pharmaceutics
- National Institute of Pharmaceutical Education and Research (NIPER)
- Hyderabad
- India
| | - Balvant Yadav
- Solid State Pharmaceutical Research Group (SSPRG)
- Department of Pharmaceutics
- National Institute of Pharmaceutical Education and Research (NIPER)
- Hyderabad
- India
| | - Rahul B. Chavan
- Global IP
- Amneal Pharmaceuticals Pvt. Ltd
- Ahmedabad–380015
- India
| | - Nalini R. Shastri
- Solid State Pharmaceutical Research Group (SSPRG)
- Department of Pharmaceutics
- National Institute of Pharmaceutical Education and Research (NIPER)
- Hyderabad
- India
| | | | - Pragna Shelat
- K. B. Institute of Pharmaceutical Education and Research
- Kadi Sarva Vishwavidyalaya
- Gandhinagar
- India
| | - Divyang Dave
- K. B. Institute of Pharmaceutical Education and Research
- Kadi Sarva Vishwavidyalaya
- Gandhinagar
- India
| |
Collapse
|
16
|
Sahraian A, Ehsaei Z, Mowla A. Aripiprazole as an adjuvant treatment for obsessive and compulsive symptoms in manic phase of bipolar disorder: A randomized, double-blind, placebo-controlled clinical trial. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:267-271. [PMID: 29544694 DOI: 10.1016/j.pnpbp.2018.03.014] [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: 01/10/2018] [Revised: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Our Objective is to study the effects of aripiprazole as an adjuvant treatment for obsessive and compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase. PATIENTS AND METHODS In this 8-week, double-blind, placebo-controlled randomized clinical trial, 56 patients with BD who had OC symptoms were randomly allocated to receive aripiprazole or placebo plus their routine medication regimen (lithium + clonazepam). Yale Brown obsessive compulsive behavior scale (YBOCS) was administered to evaluate the outcomes. Adverse effects were also registered. RESULTS Of 56 BD patients with OC symptoms which were randomly allocated in two groups of aripiprazole (n = 29) and placebo group (n = 27), 46 patients (23 in aripiprazole group and 23 in placebo group) completed the trial. Throughout the trial, the mean score of YBOCS in the aripiprazole group decreased from 21 ± 4.81 to 9.6 ± 2.2 (P < 0.001) and in the placebo group dropped from 20.46 ± 4.8 to 17.32 ± 3.7 (P < 0.001). At the end of the study, 21 (91.30%) patients in the aripiprazole group and 1 (4.34%) patient in the placebo group had >34% decline in YBOCS score (P < 0.01). No serious adverse effects were reported in any groups. CONCLUSIONS The results of our study revealed that aripiprazole can be used as an effective adjuvant agent for treatment of obsessive and compulsive symptoms in manic patients.
Collapse
Affiliation(s)
- Ali Sahraian
- Substance Abuse and Mental Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Ehsaei
- Substance Abuse and Mental Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mowla
- Substance Abuse and Mental Health Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
17
|
Azmanova M, Pitto-Barry A, Barry NPE. Schizophrenia: synthetic strategies and recent advances in drug design. MEDCHEMCOMM 2018; 9:759-782. [PMID: 30108966 PMCID: PMC6072500 DOI: 10.1039/c7md00448f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
Abstract
Schizophrenia is a complex and unpredictable mental disorder which affects several domains of cognition and behaviour. It is a heterogeneous illness characterised by positive, negative, and cognitive symptoms, often accompanied by signs of depression. In this tutorial review, we discuss recent progress in understanding the target sites and mechanisms of action of second-generation antipsychotic drugs. Progress in identifying and defining target sites has been accelerated recently by advances in neuroscience, and newly developed agents that regulate signalling by the main excitatory neurotransmitters in the brain are surveyed. Examples of novel molecules for the treatment of schizophrenia in preclinical and clinical development and their industrial sponsors are highlighted.
Collapse
Affiliation(s)
- Maria Azmanova
- School of Chemistry and Biosciences , University of Bradford , Bradford BD7 1DP , UK . ;
| | - Anaïs Pitto-Barry
- School of Chemistry and Biosciences , University of Bradford , Bradford BD7 1DP , UK . ;
| | - Nicolas P E Barry
- School of Chemistry and Biosciences , University of Bradford , Bradford BD7 1DP , UK . ;
| |
Collapse
|
18
|
Neuroprotection by aripiprazole against β-amyloid-induced toxicity by P-CK2α activation via inhibition of GSK-3β. Oncotarget 2017; 8:110380-110391. [PMID: 29299155 PMCID: PMC5746390 DOI: 10.18632/oncotarget.22777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/19/2017] [Indexed: 12/12/2022] Open
Abstract
Psychosis is reported over 30% of patients with Alzheimer's disease (AD) in clinics. Aripiprazole is an atypical antipsychotic drug with partial agonist activity at the D2 dopamine and 5-HT1A receptors with low side-effect profile. We identified aripiprazole is able to overcome the amyloid-β (Aβ)-evoked neurotoxicity and then increase the cell viability. This study elucidated the mechanism(s) by which aripiprazole ameliorates Aβ1-42-induced decreased neurite outgrowth and viability in neuronal cells. Pretreatment with aripiprazole increased Brain-derived neurotrophic factor (BDNF) mRNA and protein expressions in N2a cells. Additionally, phosphorylated casein kinase 2α at Y 255 (P-CK2α) was increased in time- and concentration-dependent manners. Furthermore, Aβ1-42-induced decreased BDNF and P-CK2α expression were increased over control level by aripiprazole. Subsequently, Aβ1-42-induced decreased levels of phosphorylated glycogen synthase-3β at Ser9 (P-GSK-3β) and nuclear P-β-catenin (Ser675) were elevated by aripiprazole, which were inhibited by K252A (inhibitor of BDNF receptor) and tetrabromocinnamic acid (TBCA, CK2 inhibitor), indicating that BDNF and P-CK2α activation are implicated in the aripiprazole effects. Expressions of cyclin D1 and insulin-like growth factor 2 (IGF2) mRNA were increased by aripiprazole; even in the presence of Aβ1-42, which was blocked by K252A and TBCA. In CK2α gene-silenced N2a cells, aripiprazole failed to increase P-GSK-3β and P-β-catenin expressions. Consequently, aripiprazole ameliorated Aβ1-42-induced attenuation of neurite elongation in HT22 cells, and this effect was blocked by both TBCA and imatinib. Decreased viability induced by Aβ1-42 was recovered by aripiprazole. These findings provide evidence supporting that aripiprazole can provide an effective therapeutic strategy against Aβ-induced neurotoxicity in AD-associated psychosis.
Collapse
|
19
|
|
20
|
Corponi F, Serretti A, Montgomery S, Fabbri C. Cariprazine specificity profile in the treatment of acute schizophrenia: a meta-analysis and meta-regression of randomized-controlled trials. Int Clin Psychopharmacol 2017; 32:309-318. [PMID: 28727644 DOI: 10.1097/yic.0000000000000189] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cariprazine is a new dopamine D2 and D3 receptor partial agonist antipsychotic. Meta-analytic evidence of efficacy in acute schizophrenia and specific groups of patients is lacking. We carried out a meta-analysis in patients with acute schizophrenia to evaluate the efficacy of cariprazine over placebo and active comparators in overall symptoms, positive and negative symptoms and quality of life. Low and high (≥6 mg/day) doses were tested separately. The possible effect of clinical-demographic modulators was also tested. Four studies (2144 patients) were included. Both high and low cariprazine doses proved superior to placebo in all symptom domains. The standardized mean difference (SMD) to placebo showed a modest impact on overall symptoms compared with meta-analytic results for other antipsychotics (SMD was similar to lurasidone, asenapine, ziprasidone and aripiprazole, but lower than risperidone, quetiapine and olanzapine). The SMD to placebo on negative symptoms was superior to many antipsychotics including aripiprazole, with a slightly more relevant effect of cariprazine low doses. This effect was probably on secondary negative symptoms since the short-term follow-up of the studies included. Meta-regression data further refined the compound clinical profile, suggesting that cariprazine may be particularly useful in young patients with a relatively short duration of disease.
Collapse
Affiliation(s)
- Filippo Corponi
- aDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy blmperial College School of Medicine, London, UK
| | | | | | | |
Collapse
|
21
|
Aripiprazole Lauroxil: Pharmacokinetic Profile of This Long-Acting Injectable Antipsychotic in Persons With Schizophrenia. J Clin Psychopharmacol 2017; 37:289-295. [PMID: 28350572 PMCID: PMC5400404 DOI: 10.1097/jcp.0000000000000691] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aripiprazole lauroxil is an extended-release prodrug of aripiprazole for intramuscular injection, approved for schizophrenia treatment. We developed a population pharmacokinetic (PopPK) model to characterize aripiprazole lauroxil PK and evaluate dosing scenarios likely to be encountered in clinical practice. METHODS Data from 616 patients with schizophrenia, collected from 5 clinical studies, were used to construct the PopPK model. The model was subsequently used to evaluate various dose levels and frequency and the impact of dosing delay on aripiprazole concentrations. FINDINGS The results of the model indicate that aripiprazole is released into the systemic circulation after 5 to 6 days, and release continues for an additional 36 days. The slow increase in aripiprazole concentration after injection necessitates the coadministration of oral aripiprazole for 21 days with the first injection. Based on the PopPK model simulations, a dosing interval of 882 mg every 6 weeks results in aripiprazole concentrations that fall within the concentration range associated with the efficacious aripiprazole lauroxil dose range (441-882 mg dosed monthly). A 662-mg monthly dose also resulted in aripiprazole concentrations within the efficacious dose range. Aripiprazole lauroxil administration results in prolonged exposure, such that dose delays of 2 to 4 weeks, depending on the dose regimen, do not require oral aripiprazole supplementation upon resumption of dosing. CONCLUSIONS This PopPK model and model-based simulations were effective means for evaluating aripiprazole lauroxil dosing regimens and management of missed doses. Such analyses play an important role in determining the use of this long-acting antipsychotic in clinical practice.
Collapse
|
22
|
Gunasekaran K, Murthi S, Jennings J, Lone N. Aripiprazole-induced hypersensitivity pneumonitis. BMJ Case Rep 2017; 2017:bcr-2017-219929. [PMID: 28487307 DOI: 10.1136/bcr-2017-219929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Aripiprazole is an atypical antipsychotic agent commonly used in the management of schizophrenia. Aripiprazole has not been reported to have an association with interstitial lung disease. We describe a case of a 36-year-old woman who began to experience respiratory issues shortly after starting aripiprazole and presented to us 4 years later with progressive exertional shortness of breath. High-resolution CT of the chest showed a bilateral ground glass pattern. Video-assisted thoracoscopy with biopsy revealed alveolar septal thickening and an inflammatory infiltrate composed mainly of lymphocytes, suggestive of chronic hypersensitivity pneumonitis. After discontinuing aripiprazole and initiating prednisolone therapy, the patient's pulmonary symptoms improved. This case highlights that aripiprazole can cause hypersensitivity pneumonitis in susceptible individuals.
Collapse
Affiliation(s)
| | - Swetha Murthi
- Internal Medicine, Sinai Grace Hospital, Detroit, USA
| | - Jeffrey Jennings
- Division of Pulmonary and Critical Care, Henry Ford Health System, Detroit, USA
| | - Nazir Lone
- Internal Medicine, Pulmonary and Critical Care, Bassett Healthcare, Cooperstown, USA
| |
Collapse
|
23
|
Tadokoro S, Nonomura N, Kanahara N, Hashimoto K, Iyo M. Reduction of Severity of Recurrent Psychotic Episode by Sustained Treatment with Aripiprazole in a Schizophrenic Patient with Dopamine Supersensitivity: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:79-81. [PMID: 28138118 PMCID: PMC5290712 DOI: 10.9758/cpn.2017.15.1.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 01/08/2023]
Abstract
Dopamine supersensitivity psychosis (DSP) is a type of acute exacerbation of recurrent psychosis caused by long-term treatment with antipsychotics in schizophrenic patients. Although DSP is exceedingly troublesome for clinicians, effective treatment has not yet been established. Based on clinical research and our animal study, we hypothesize that aripiprazole, an atypical anti-psychotic, may reduce the exacerbation of recurrent psychotic episodes. We report the case of a 46-year-old female who suffered from schizophrenia with DSP. In this case, sustained treatment with a high dose of aripiprazole gradually reduced the severity of her recurrent psychotic episodes. In conclusion, sustained treatment with aripiprazole may reduce the exacerbation of recurrent psychotic episodes in schizophrenic patients with DSP, and may be an effective treatment of DSP.
Collapse
Affiliation(s)
- Shigenori Tadokoro
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Health Administration Center, Muroran Institute of Technology, Hokkaido, Japan
| | - Naho Nonomura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Biomedical Ethics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
24
|
Hammoudeh S, Ghuloum S, Mahfoud Z, Opler M, Khan A, Yehya A, Abdulhakam A, Al-Mujalli A, Hani Y, Elsherbiny R, Al-Amin H. Reliability, validity and factorial structure of the Arabic version of the international suicide prevention trial (InterSePT) scale for suicidal thinking in schizophrenia patients in Doha, Qatar. BMC Psychiatry 2016; 16:437. [PMID: 27927173 PMCID: PMC5142345 DOI: 10.1186/s12888-016-1155-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with schizophrenia are known to have higher rates of mortality and morbidity when compared to the general population. Suicidality is a major contributor to increased mortality. The International Suicide Prevention Trial (InterSePT) Scale for Suicidal Thinking (ISST) is a validated tool to assess current suicidal ideation in patients with schizophrenia. The aims of the study were to culturally adapt the Arabic translation of ISST and to examine the psychometric characteristics of the Arabic version of the ISST among patients with schizophrenia in Qatar. METHODS ISST was translated and adapted into formal Arabic using the back translation method. Patients diagnosed with schizophrenia were randomly recruited from the department of Psychiatry, Rumailah Hospital, Doha, Qatar. Healthy controls were randomly recruited from two primary health care centers in Doha, Qatar. The Arabic version of Module B for suicidality in Mini International Neuropsychiatric Interview was used as the gold standard to which the Arabic ISST was compared. RESULTS The study sample (n = 199) was composed of 100 patients diagnosed with schizophrenia (age 35.30 ± 10.04 years; M/F is 2/1) and 99 controls (age 33.98 ± 8.33 years; M/F is 2/3). The mean score on the ISST was 3.03 ± 4.75 vs. 0.47 ± 1.44 for the schizophrenia and control groups, respectively. Inter-rater reliability coefficient was 0.95, p > 0.001. The overall Cronbach's alpha was 0.92. Principal Component Analysis produced 3 factors explaining a total of 73.8% of variance. CONCLUSIONS This is the first study in the Arab countries to validate the Arabic version of the ISST. The psychometric properties indicate that the Arabic ISST is a valid tool to assess the severity of suicidal ideation in Arabic patients with schizophrenia.
Collapse
Affiliation(s)
- Samer Hammoudeh
- Department of Research, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Health Policy and Research, Weill Cornell Medicine - Qatar, Doha, Qatar
| | | | | | - Arij Yehya
- Department of Research, Weill Cornell Medicine - Qatar, Doha, Qatar
| | | | | | - Yahya Hani
- Department of Psychiatry, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Reem Elsherbiny
- Department of Research, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Hassen Al-Amin
- Department of Psychiatry, Weill Cornell Medicine - Qatar, Education City, P.O. Box 24144, Doha, Qatar.
| |
Collapse
|
25
|
Amodeo G, Candiracci C, Capecci I, De Filippis S, Giuliani S, Guerani G, Tomasetti C, Villari V, Fagiolini A. Starting aripiprazole long-acting-once-a-month early in treatment: why, how and for whom? Expert consensus and practical recommendations by a panel of Italian clinicians. Expert Opin Pharmacother 2016; 17:2143-2147. [PMID: 27690670 DOI: 10.1080/14656566.2016.1244526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Aripiprazole long acting once-monthly (AOM) is approved for the treatment of schizophrenia in adults. Despite recent evidence of AOM efficacy in the acute treatment of schizophrenia, it is recommended that AOM should be started once the acute symptoms are controlled and patients are stabilized. However, there currently are no definitive guidelines exactly describing when a patient is to be considered stabilized enough to start AOM and which the patients are for whom an early AOM start is to be preferred. Areas covered: A panel of Italian clinicians experienced with real world use of AOM met to discuss the scenarios where an early (i.e., immediately after controlling the acute symptoms) start of AOM may be suggested. Real life clinical experiences were shared and a consensus was reached. Expert opinion: There are cases when the risks/benefits ratio suggests to start AOM early, i.e. immediately after the acute symptoms have been stabilized, as opposed to starting it several days/weeks after the stabilization of acute symptoms. Clinical pearls, guidelines and opinions are provided.
Collapse
Affiliation(s)
- Giovanni Amodeo
- a Department of Mental Health and Dept of Molecular Medicine , University of Siena Medical Center , Siena , Italy
| | - Chiara Candiracci
- b Department of Mental Health , Italy National Health Service , Pesaro , Italy
| | - Ilaria Capecci
- c Department of Mental Health , Italy National Health Service , Jesi , Italy
| | - Sergio De Filippis
- d Department of Psychiatry , University of Rome and Villa Von Siebenthal Clinic and Rehabilitation Center , Rome , Italy
| | - Sonia Giuliani
- e Department of Mental Health , Italy National Health Service , Senigallia , Italy
| | - Giorgio Guerani
- f Department of Mental Health , Italy National Health Service , Rome , Italy
| | - Carmine Tomasetti
- g Department of Mental Health , AUSL 4 Teramo, Psychiatric Service for Diagnosis and Treatment of Giulianova (TE) , Italy.,h Department of Neuroscience, Reproductive and Odontostomatological Sciences , University Medical School of Naples 'Federico II' , Napoli , Italy
| | - Vincenzo Villari
- i Department of Mental Health , Italy National Health Service , Torino , Italy
| | - Andrea Fagiolini
- a Department of Mental Health and Dept of Molecular Medicine , University of Siena Medical Center , Siena , Italy
| |
Collapse
|
26
|
Abstract
Delirium is a palliative care emergency where patients experience changes in perception, awareness, and behavior. Common features include changes in the sleep-wake cycle, emotional lability, delusional thinking, and language and thought disorders. Delirium results from neurotransmitter imbalances involving several neurotransmitters such as dopamine, glutamate, norepinephrine, acetylcholine, gamma-aminobutyric acid, and serotonin. Untreated delirium causes significant morbidity and mortality. Nonpharmacologic and pharmacologic approaches treat delirium. Current pharmacologic management of delirium involves using agents such as haloperidol or second-generation antipsychotics. Third-generation atypical antipsychotic drugs have emerged as a potential choice for delirium management. Aripiprazole is a third-generation antipsychotic with a dopamine receptor-binding profile distinct from other second-generation antipsychotics. Aripiprazole acts as partial agonist at dopamine D2 and 5-hydroxytryptamine (5-HT)1A receptors, stabilizing the dopamine receptor leading to improvement in symptoms. The article reviews the pharmacology, pharmacodynamics, metabolism, and evidence of clinical efficacy for this new antipsychotic agent. This article explores possible roles in palliative care.
Collapse
Affiliation(s)
- Eric Prommer
- 1 Greater Los Angeles Healthcare, Los Angeles, CA, USA
| |
Collapse
|
27
|
The effect of brexpiprazole (OPC-34712) and aripiprazole in adult patients with acute schizophrenia: results from a randomized, exploratory study. Int Clin Psychopharmacol 2016; 31:192-201. [PMID: 26963842 DOI: 10.1097/yic.0000000000000123] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to explore the effects of brexpiprazole and aripiprazole on efficacy, cognitive functioning, and safety in patients with acute schizophrenia. Patients who would benefit from hospitalization/continued hospitalization for acute relapse of schizophrenia were enrolled and randomized (2 : 1) to target doses of open-label brexpiprazole 3 mg/day or aripiprazole 15 mg/day for 6 weeks. Outcomes included change from baseline to week 6 in the Positive and Negative Syndrome Scale total score, Barratt Impulsiveness Scale 11-item score, and Cogstate computerized cognitive test battery scores. Patients treated with brexpiprazole (n=64) or aripiprazole (n=33) showed reductions in symptoms of schizophrenia as assessed by Positive and Negative Syndrome Scale total score (-22.9 and -19.4, respectively). A modest reduction in impulsivity was observed with brexpiprazole, but not aripiprazole (mean change in the Barratt Impulsiveness Scale 11-item total score: -2.7 and 0.1, respectively). No change in Cogstate scores was observed for either treatment. Brexpiprazole was well tolerated and the incidence of akathisia was lower in patients treated with brexpiprazole (9.4%) than aripiprazole (21.2%). Clinically relevant improvements in psychopathology were observed in patients with acute schizophrenia treated with brexpiprazole or aripiprazole. Brexpiprazole was well tolerated, with a lower incidence of akathisia than aripiprazole.
Collapse
|
28
|
Wang M, Zhang Y, Wang T, Wang C, Xue D, Xiao J. Story of an Age-Old Reagent: An Electrophilic Chlorination of Arenes and Heterocycles by 1-Chloro-1,2-benziodoxol-3-one. Org Lett 2016; 18:1976-9. [PMID: 27074528 DOI: 10.1021/acs.orglett.6b00547] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
By the use of 1-chloro-1,2-benziodoxol-3-one, an age-old reagent, the practical and efficient chlorination method is achieved. This hypervalent iodine reagent is amenable not only to the chlorination of nitrogen-containing heterocycles but also to selected classes of arenes, BODIPY dyes, and pharmaceuticals. In addition, the advantages, such as easy preparation and recyclable, air- and moisture-stable, in combination with the success in a gram-scale experiment grant this reagent great potential for industrial application.
Collapse
Affiliation(s)
- Mengzhou Wang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710062, China
| | - Yanyan Zhang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710062, China
| | - Tao Wang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710062, China
| | - Chao Wang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710062, China
| | - Dong Xue
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710062, China
| | - Jianliang Xiao
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University , Xi'an 710062, China.,Department of Chemistry, University of Liverpool , Liverpool L69 7ZD, United Kingdom
| |
Collapse
|
29
|
Fagiolini A, Alfonsi E, Amodeo G, Cenci M, Di Lella M, Farinella F, Ferraiuolo F, Fraguas D, Loparco N, Gutierrez-Rojas L, Mignone ML, Pataracchia G, Pillai G, Russo F, Sanchez-Gistau V, Spinogatti F, Toscano M, Villari V, De Filippis S. Switching long acting antipsychotic medications to aripiprazole long acting once-a-month: expert consensus by a panel of Italian and Spanish psychiatrists. Expert Opin Drug Saf 2016; 15:449-55. [DOI: 10.1517/14740338.2016.1155553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrea Fagiolini
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Emilia Alfonsi
- Department of Mental Health, National Health Service, Ancona, Italy
| | - Giovanni Amodeo
- Department of Mental Health and Deparment of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Mario Cenci
- Department of Mental Health, Fabriano, Italy
| | - Michele Di Lella
- Department of Mental Health, National Health Service, Alessandria, Italy
| | | | | | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Madrid, Spain
| | - Natale Loparco
- Department of Mental Health, National Health Service, Taranto, Italy
| | - Luis Gutierrez-Rojas
- Departamento de Psiquiatría, Hospital Clínico, Granada - Complejo Hospitalario Granada, Granada, Spain
| | | | | | - Gianluca Pillai
- Department of Mental Health, National Health Service, Oristano, Italy
| | - Felicia Russo
- Servizio Psichiatrico di Diagnosi e Cura, Ospedale F. Fallacara, Triggiano and Department of Mental Health, National Health Service, Bari, Italy
| | - Vanessa Sanchez-Gistau
- Early Intervention Psychosis Service, Hospital Universitari Insitut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Franco Spinogatti
- Department of Mental Health, National Health Service, Cremona, Italy
| | - Marco Toscano
- Department of Mental Health, ASST Rhodense, Garbagnate M.se, Italy
| | - Vincenzo Villari
- Department of Mental Health, National Health Service, Torino, Italy
| | - Sergio De Filippis
- Casa di Cura Neuropsichiatrica e Comunità Terapeutica-Genzano, University of Rome and Villa Von Siebenthal, Rome, Italy
| |
Collapse
|
30
|
Soponar F, Sandru M, David V. Dependence of reversed-phase liquid chromatographic retention for aripiprazole and some related chemical impurities on the main elution parameters. J LIQ CHROMATOGR R T 2016. [DOI: 10.1080/10826076.2015.1126729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Florin Soponar
- Faculty of Chemistry, Department of Analytical Chemistry, University of Bucharest, Bucharest, Romania
- Research and Development Center, S.C. Polipharma Industries S.R.L., Sibiu, Romania
| | - Mihaela Sandru
- Research and Development Center, S.C. Polipharma Industries S.R.L., Sibiu, Romania
| | - Victor David
- Faculty of Chemistry, Department of Analytical Chemistry, University of Bucharest, Bucharest, Romania
| |
Collapse
|
31
|
Lodhi RJ, Masand S, Malik A, Shivakumar K, McAllister VDM, O'Keane V, Young LC, Heald AH, Sherwood RA, Aitchison KJ. Changes in biomarkers of bone turnover in an aripiprazole add-on or switching study. Schizophr Res 2016; 170:245-51. [PMID: 26792297 DOI: 10.1016/j.schres.2015.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The association between mental illness and osteoporosis and fractures is particularly pronounced in psychotic disorders. Antipsychotic use has previously been described to affect bone density. METHOD A 52-week follow-up of patients switched to aripiprazole or with aripiprazole added on, conducting a specific analysis of markers of bone turnover: urinary NTX (a biomarker of bone resorption) and serum BSAP (a biomarker of bone formation). Baseline and serial measurements of bone markers NTX, BSAP and of hormones prolactin, oestrogen and testosterone were done at weeks 0 and 1, 2, 6, 12, 26 and 52, respectively. RESULTS NTX concentration reduced over time but this did not reach significance in the whole group (log-NTX: β=-0.0012, p=0.142). For BSAP the addition of or replacement with aripiprazole produced a significant reduction (log-BSAP: β=-0.00039, p=0.002). Analysis with prolactin similarly showed a significant reduction (log-prolactin: β=-0.0024, p<0.001); other hormones did not change significantly. Sensitivity analysis to compare the switchers to aripiprazole versus the "add-on" showed that the former group had a significant reduction in NTX. CONCLUSIONS We found that switching to aripiprazole was associated with changes in molecular biomarkers of bone resorption, indicating a more favourable profile for bone health.
Collapse
Affiliation(s)
- Rohit J Lodhi
- Department of Psychiatry, University of Alberta, Canada.
| | | | - Amna Malik
- Lewisham Primary Care Psychological Therapies Service, Deptford, UK; COAST Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kuppuswami Shivakumar
- Department of Psychiatry, Northern Ontario School of Medicine, Sudbury, Ontario, Canada; COAST Team, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Leah C Young
- Department of Psychiatry, University of Alberta, Canada
| | - Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Roy A Sherwood
- Department of Clinical Biochemistry, King's College Hospital, London
| | - Katherine J Aitchison
- Department of Psychiatry, University of Alberta, Canada; COAST Team, South London and Maudsley NHS Foundation Trust, London, UK; Department of Medical Genetics, University of Alberta, Canada; Kings College London, MRC SGDP Centre, UK
| |
Collapse
|
32
|
Gaviria AM, Franco JG, Aguado V, Rico G, Labad J, de Pablo J, Vilella E. A Non-Interventional Naturalistic Study of the Prescription Patterns of Antipsychotics in Patients with Schizophrenia from the Spanish Province of Tarragona. PLoS One 2015; 10:e0139403. [PMID: 26427051 PMCID: PMC4591292 DOI: 10.1371/journal.pone.0139403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/10/2015] [Indexed: 12/28/2022] Open
Abstract
Background The analysis of prescribing patterns in entire catchment areas contributes to global mapping of the use of antipsychotics and may improve treatment outcomes. Objective To determine the pattern of long-term antipsychotic prescription in outpatients with schizophrenia in the province of Tarragona (Catalonia-Spain). Methods A naturalistic, observational, retrospective, non-interventional study based on the analysis of registries of computerized medical records from an anonymized database of 1,765 patients with schizophrenia treated between 2011 and 2013. Results The most used antipsychotic was risperidone, identified in 463 (26.3%) patients, followed by olanzapine in 249 (14.1%), paliperidone in 225 (12.7%), zuclopenthixol in 201 (11.4%), quetiapine in 141 (8%), aripiprazole in 100 (5.7%), and clozapine in 100 (5.7%). Almost 8 out of 10 patients (79.3%) were treated with atypical or second-generation antipsychotics. Long-acting injectable (LAI) formulations were used in 44.8% of patients. Antipsychotics were generally prescribed in their recommended doses, with clozapine, ziprasidone, LAI paliperidone, and LAI risperidone being prescribed at the higher end of their therapeutic ranges. Almost 7 out of 10 patients (69.6%) were on antipsychotic polypharmacy, and 81.4% were on psychiatric medications aside from antipsychotics. Being prescribed quetiapine (OR 14.24, 95% CI 4.94–40.97), LAI (OR 9.99, 95% CI 6.45–15.45), psychiatric co-medications (OR 4.25, 95% CI 2.72–6.64), and paliperidone (OR 3.13, 95% CI 1.23–7.92) were all associated with an increased likelihood of polypharmacy. Being prescribed risperidone (OR 0.54, 95% CI 0.35–0.83) and older age (OR 0.98, 95% CI 0.97–0.99) were related to a low polypharmacy probability. Conclusions Polypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics or antidepressants. Polypharmacy is associated with the use of quetiapine or paliperidone, use of a LAI, younger age, and psychiatric co-medication.
Collapse
Affiliation(s)
- Ana M. Gaviria
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| | - José G. Franco
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
- * E-mail:
| | - Víctor Aguado
- Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Guillem Rico
- Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Javier Labad
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| | - Joan de Pablo
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| |
Collapse
|
33
|
Lockwood JT, Remington G. Emerging drugs for antipsychotic-induced tardive dyskinesia: investigational drugs in Phase II and Phase III clinical trials. Expert Opin Emerg Drugs 2015; 20:407-21. [DOI: 10.1517/14728214.2015.1050376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
34
|
Aripiprazole (ABILIFY MAINTENA®): a review of its use as maintenance treatment for adult patients with schizophrenia. Drugs 2015; 74:1097-110. [PMID: 24969315 DOI: 10.1007/s40265-014-0231-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aripiprazole (ABILIFY(®)) is an atypical antipsychotic drug that is proposed to act via partial agonism of dopamine D2 receptors. Trials with oral aripiprazole have shown that, compared with some other atypical antipsychotics, aripiprazole is associated with fewer metabolic disturbances and has a favourable cardiovascular tolerability profile. Recently, an intramuscular long-acting injectable (LAI) depot formulation of aripiprazole (ABILIFY MAINTENA(®)) (aripiprazole LAI) has been approved for use as a treatment for schizophrenia in adults. The efficacy of aripiprazole LAI as a maintenance treatment for schizophrenia has been demonstrated in randomized clinical trials. In the trials, aripiprazole LAI was more effective than placebo, and noninferior to oral aripiprazole, in delaying relapse and in reducing relapse rates in schizophrenia. Aripiprazole LAI was generally well tolerated, with a tolerability profile consistent with that of oral aripiprazole. Thus, aripiprazole LAI is a valuable new treatment option for adult patients with schizophrenia. It may be of particular use for patients stable on oral aripiprazole who would prefer, or are likely to benefit from, a long-acting formulation.
Collapse
|
35
|
Srisurapanont M, Suttajit S, Maneeton N, Maneeton B. Efficacy and safety of aripiprazole augmentation of clozapine in schizophrenia: a systematic review and meta-analysis of randomized-controlled trials. J Psychiatr Res 2015; 62:38-47. [PMID: 25619176 DOI: 10.1016/j.jpsychires.2015.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/17/2014] [Accepted: 01/09/2015] [Indexed: 12/20/2022]
Abstract
Limited options are available for clozapine-resistant schizophrenia and intolerable side effects of clozapine. We conducted a systematic review of randomized-controlled trials (RCTs) to determine the efficacy and safety of aripiprazole augmentation of clozapine for schizophrenia. Electronic databases searched included PubMed, Scopus, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. This review synthesized the data of four short-term (8-24 weeks), placebo-controlled trials (N = 347). The overall relative risk (RR, 95% confidence interval) of discontinuation rates was not significantly different between groups (RR = 1.41, 95% CI = 0.78 to 2.56). The pooled standardized mean differences (SMDs, 95% CIs) (Z-test; number of study; I(2)-index) suggested trends of aripiprazole augmentation benefits on overall psychotic [-0.40 (-0.87 to 0.07) (n = 3; Z = 1.68, p = 0.09; I(2) = 68%)], positive [-1.05 (-2.39 to 0.29) (n = 3; Z = 1.54, p = 0.12; I(2) = 94%)], and negative [-0.36 (-0.77 to 0.05) (n = 3; Z = 1.74, p = 0.08; I(2) = 54%)] symptoms. Despite of no benefit on three cardiometabolic indices (i.e., fasting plasma glucose, triglyceride, and high-density lipoprotein), aripiprazole augmentation was superior for weight change with a mean difference (95% CI) of -1.36 kg (-2.35 to -0.36) (n = 3; Z = 2.67, p = 0.008; I(2) = 39%) and LDL-cholesterol with a mean difference of -11.06 mg/dL (-18.25 to -3.87) (n = 3; Z = 3.02, p = 0.003; I(2) = 31%). Aripiprazole augmentation was not correlated with headache and insomnia but significantly associated with agitation/akathesia (RR = 7.59, 95% CI = 1.43 to 40.18) (n = 3; Z = 2.38, p = 0.02; I(2) = 0%) and anxiety (RR = 2.70, 95% CI = 1.02 to 7.15) (n = 1; Z = 2.00, p = 0.05). The limited short-term data suggested that aripiprazole augmentation of clozapine can minimize the cardiometabolic risk, causes agitation/akathesia, and may be effective in attenuating psychotic symptoms.
Collapse
Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
36
|
Fagiolini A, Brugnoli R, Di Sciascio G, De Filippis S, Maina G. Switching antipsychotic medication to aripiprazole: position paper by a panel of Italian psychiatrists. Expert Opin Pharmacother 2015; 16:727-37. [DOI: 10.1517/14656566.2015.1013029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
37
|
Affiliation(s)
- Lisa Dixon
- Department of Psychiatry, Columbia University Medical Center, New York, NY;
| | | |
Collapse
|
38
|
Fleischhacker WW, Sanchez R, Perry PP, Jin N, Peters-Strickland T, Johnson BR, Baker RA, Eramo A, McQuade RD, Carson WH, Walling D, Kane JM. Aripiprazole once-monthly for treatment of schizophrenia: double-blind, randomised, non-inferiority study. Br J Psychiatry 2014; 205:135-44. [PMID: 24925984 DOI: 10.1192/bjp.bp.113.134213] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents. AIMS To assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia. METHOD A 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10-30 mg/day) or aripiprazole once-monthly 50 mg (a dose below the therapeutic threshold for assay sensitivity). ( TRIAL REGISTRATION clinicaltrials.gov, NCT00706654.) RESULTS A total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan-Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400 mg and 7.76% for oral aripiprazole. This difference (-0.64%, 95% CI -5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50 mg (21.80%, P < or = 0.001). CONCLUSIONS Aripiprazole once-monthly 400 mg was non-inferior to oral aripiprazole, and the reduction in Kaplan-Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.
Collapse
Affiliation(s)
- W Wolfgang Fleischhacker
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Raymond Sanchez
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Pamela P Perry
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Na Jin
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Timothy Peters-Strickland
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Brian R Johnson
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Ross A Baker
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Anna Eramo
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Robert D McQuade
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - William H Carson
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - David Walling
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - John M Kane
- W. Wolfgang Fleischhacker, MD, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria; Raymond Sanchez, MD, Pamela P. Perry, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Na Jin, MS, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, Maryland, USA; Timothy Peters-Strickland, MD, Brian R. Johnson, MS, Ross A. Baker, PhD, MBA, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; Anna Eramo, MD, Lundbeck LLC, Deerfield, Illinois, USA; Robert D. McQuade, PhD, William H. Carson, MD, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, USA; David Walling, PhD, Collaborative NeuroScience Network, Inc., Garden Grove, California, USA; John M. Kane, MD, The Zucker Hillside Hospital, Glen Oaks, and the Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| |
Collapse
|
39
|
Rohde M, M?rk N, Håkansson AE, Jensen KG, Pedersen H, Dige T, J?rgensen EB, Holm R. Biological conversion of aripiprazole lauroxil - An N-acyloxymethyl aripiprazole prodrug. RESULTS IN PHARMA SCIENCES 2014; 4:19-25. [PMID: 25756003 PMCID: PMC4050360 DOI: 10.1016/j.rinphs.2014.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 11/19/2022]
Abstract
N-acyloxyalkylation of NH-acidic compounds can be a prodrug approach for e.g. tertiary or some N-heterocyclic amines and secondary amides and have the potential to modify the properties of the parent drug for specific uses, for example its physicochemical, pharmacokinetic or biopharmaceutical properties. Aripiprazole lauroxil was prepared as a model compound for such prodrugs and its bioconversion was investigated both in vitro and in vivo. Theoretically, N-acyloxyalkyl derivates of NH-acid compounds undergo a two-step bioconversion into the parent NH-acidic drug through an N-hydroxyalkyl intermediate. However, to our knowledge no published studies have investigated the formation of an intermediate in vivo. In the present study, it was demonstrated that the assumed N-hydroxymethyl intermediate was readily observed both in vitro and in vivo. In vivo, the observed plasma concentration of the intermediate was at the same level as the drug (aripiprazole). When prodrug intermediates are formed, it is important to make a proper pharmacological, pharmacokinetic and toxicological evaluation of the intermediates to ensure patient safety; however, several challenges were identified when testing an N-acyloxyalkyl prodrug. These included the development of a suitable bioanalytical method, the accurate prediction of prodrug bioconversion and thereby the related pharmacokinetics in humans and the toxicological potential of the intermediate.
Collapse
Affiliation(s)
- Morten Rohde
- Bioanalysis, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| | - Niels M?rk
- Corporate Project Management R&D, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| | | | - Klaus G. Jensen
- Drug ADME Research, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| | - Henrik Pedersen
- Compound Management and Analytical Chemistry, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| | - Tina Dige
- Bioanalysis, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| | - Erling B. J?rgensen
- Biologics and Pharmaceutical Science, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| | - René Holm
- Biologics and Pharmaceutical Science, H. Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark
| |
Collapse
|
40
|
Varela FA, Der-Ghazarian T, Lee RJ, Charntikov S, Crawford CA, McDougall SA. Repeated aripiprazole treatment causes dopamine D2 receptor up-regulation and dopamine supersensitivity in young rats. J Psychopharmacol 2014; 28:376-86. [PMID: 24045880 PMCID: PMC5673084 DOI: 10.1177/0269881113504016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aripiprazole is a second-generation antipsychotic that is increasingly being prescribed to children and adolescents. Despite this trend, little preclinical research has been done on the neural and behavioral actions of aripiprazole during early development. In the present study, young male and female Sprague-Dawley rats were pretreated with vehicle, haloperidol (1 mg/kg), or aripiprazole (10 mg/kg) once daily on postnatal days (PD) 10-20. After 1, 4, or 8 days (i.e. on PD 21, PD 24, or PD 28), amphetamine-induced locomotor activity and stereotypy, as well as dorsal striatal D2 receptor levels, were measured in separate groups of rats. Pretreating young rats with aripiprazole or haloperidol increased D2 binding sites in the dorsal striatum. Consistent with these results, dopamine supersensitivity was apparent when aripiprazole- and haloperidol-pretreated rats were given a test day injection of amphetamine (2 or 4 mg/kg). Increased D2 receptor levels and altered behavioral responding persisted for at least 8 days after conclusion of the pretreatment regimen. Contrary to what has been reported in adults, repeated aripiprazole treatment caused D2 receptor up-regulation and persistent alterations of amphetamine-induced behavior in young rats. These findings are consistent with human clinical studies showing that children and adolescents are more prone than adults to aripiprazole-induced side effects, including extrapyramidal symptoms.
Collapse
Affiliation(s)
- Fausto A. Varela
- Department of Psychology, California State University, San Bernardino, CA, USA
| | - Taleen Der-Ghazarian
- Department of Psychology, California State University, San Bernardino, CA, USA,School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Ryan J. Lee
- Department of Psychology, California State University, San Bernardino, CA, USA
| | - Sergios Charntikov
- Department of Psychology, California State University, San Bernardino, CA, USA,Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Cynthia A. Crawford
- Department of Psychology, California State University, San Bernardino, CA, USA
| | | |
Collapse
|
41
|
Grandgeorge M, Lemonnier E, Degrez C, Jallot N. The effect of bumetanide treatment on the sensory behaviours of a young girl with Asperger syndrome. BMJ Case Rep 2014; 2014:bcr-2013-202092. [PMID: 24488662 DOI: 10.1136/bcr-2013-202092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Sensory behaviours were not considered as core features of autism spectrum disorders until recently. However, they constitute an important part of the observed symptoms that result in social maladjustment and are currently quite difficult to treat. One promising strategy for the treatment of these behaviours is the use of bumetanide, which was previously shown to reduce the severity of autism spectrum disorders. In this study, we proposed to evaluate sensory behaviours using Dunn's Sensory Profile after 18 months of bumetanide treatment in a 10-year-old girl with Asperger syndrome. Reported improvements covered a large range of sensory behaviours, including auditory, vestibular, tactile, multisensory and oral sensory processing. Although our results were limited to a single case report, we believe that our clinical observations warrant clinical trials to test the long-term efficacy of bumetanide to manage the sensory behaviours of people with autism spectrum disorders.
Collapse
|
42
|
A translational pharmacology approach to understanding the predictive value of abuse potential assessments. Behav Pharmacol 2013; 24:410-36. [PMID: 23873088 DOI: 10.1097/fbp.0b013e3283644d2e] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Within the drug development industry the assessment of abuse potential for novel molecules involves the generation and review of data from multiple sources, ranging from in-vitro binding and functional assays through to in-vivo nonclinical models in mammals, as well as collection of information from studies in humans. This breadth of data aligns with current expectations from regulatory agencies in both the USA and Europe. To date, there have been a limited number of reviews on the predictive value of individual models within this sequence, but there has been no systematic review on how each of these models contributes to our overall understanding of abuse potential risk. To address this, we analyzed data from 100 small molecules to compare the predictive validity for drug scheduling status of a number of models that typically contribute to the abuse potential assessment package. These models range from the assessment of in-vitro binding and functional profiles at receptors or transporters typically associated with abuse through in-vivo models including locomotor activity, drug discrimination, and self-administration in rodents. Data from subjective report assessments in humans following acute dosing of compounds were also included. The predictive value of each model was then evaluated relative to the scheduling status of each drug in the USA. In recognition of the fact that drug scheduling can be influenced by factors other than the pharmacology of the drug, we also evaluated the predictive value of each assay for the outcome of the human subjective effects assessment. This approach provides an objective and statistical assessment of the predictive value of many of the models typically applied within the pharmaceutical industry to evaluate abuse potential risk. In addition, the impact of combining information from multiple models was examined. This analysis adds to our understanding of the predictive value of each model, allows us to critically evaluate the benefits and limitations of each model, and provides a method for identifying opportunities for improving our assessment and prediction of abuse liability risk in the future.
Collapse
|
43
|
|
44
|
De Deyn PP, Drenth AFJ, Kremer BP, Oude Voshaar RC, Van Dam D. Aripiprazole in the treatment of Alzheimer's disease. Expert Opin Pharmacother 2013; 14:459-74. [PMID: 23350964 DOI: 10.1517/14656566.2013.764989] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Psychosis is a common and difficult to treat symptom in Alzheimer's disease (AD). It is a cause of diminished quality of life and caregiver distress. Atypical antipsychotics are frequently used for the treatment of dementia-related psychosis, despite FDA warnings because of increased mortality associated with the use of these medications in dementia patients. Aripiprazole is a newer atypical antipsychotic drug with partial agonist activity at dopamine receptors and antagonist activity at 5-HT(2A) receptors, with a low side-effect profile. AREAS COVERED This descriptive review gives a short overview of the pathology and epidemiology of AD, including psychotic symptoms, and describes the mode of action of aripiprazole and results of preclinical studies. Finally, randomized controlled trials evaluating the use of aripiprazole in AD-related psychosis and agitation are discussed. Whenever relevant, meta-analytical data from literature are referred to. EXPERT OPINION In randomized placebo-controlled clinical trials, aripiprazole shows modest efficacy in the treatment of AD-related psychosis. Neuropsychiatric symptoms alleviated were predominantly psychotic features and agitation. In individual trials, aripiprazole was generally well tolerated, serious side effects were seldom reported and included accidental injury and somnolence. Meta-analyses however demonstrated increased mortality as a class effect for atypical, but also for typical antipsychotics. No increased cardiovascular outcomes, cerebrovascular accidents, increased appetite or weight gain were demonstrated in meta-analyses for aripiprazole-treated patients with psychosis of dementia. Aripiprazole was found to induce sedation. Aripiprazole should only be used in selected patient populations resistant to non-pharmacological treatment with persisting or severe psychotic symptoms and/or agitation, and in which symptoms lead to significant morbidity, patient suffering and potential self-harm. The indication for continuing treatment should be revised regularly.
Collapse
Affiliation(s)
- Peter Paul De Deyn
- University of Groningen, University Medical Center Groningen, Alzheimer Research Center, Department of Neurology, 9713 GZ Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|
45
|
Hartmann A, Worbe Y. Pharmacological treatment of Gilles de la Tourette syndrome. Neurosci Biobehav Rev 2012; 37:1157-61. [PMID: 23137552 DOI: 10.1016/j.neubiorev.2012.10.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/10/2012] [Accepted: 10/28/2012] [Indexed: 11/25/2022]
Abstract
Pharmacological treatment is usually indicated in moderate to severe tics in psychosocial and/or functional impairment. Neuroleptics with D2 antagonistic activity remain the cornerstone of anti-tic therapy. Lack of randomized controlled clinical trials base therapeutic decisions mainly on clinical expertise and common sense. Recently, aripiprazole has emerged as the neuroleptic with the most advantageous efficacy/side effect ratio for treating tics. Yet, in non-responders to aripiprazole, many neuroleptic and non-neuroleptic drugs, including botulinum toxin injections, are available and often successful. Apart from conducting methodologically sound trials (which includes sufficiently long observation periods), future efforts in the field should test the combination of cognitive-behavioral therapy with drugs or of multi-drug therapy as well as the development of biomarkers (endophenotypes) to monitor and even predict treatment response.
Collapse
Affiliation(s)
- Andreas Hartmann
- Centre de Référence National Maladie Rare: Syndrome Gilles de la Tourette, Département de Neurologie, Pôle des Maladies du Système Nerveux, France.
| | | |
Collapse
|
46
|
Effect of aripiprazole on verbal memory and fluency in schizophrenic patients : results from the ESCAPE study. CNS Drugs 2012; 26:975-82. [PMID: 23018547 DOI: 10.1007/s40263-012-0003-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Second-generation antipsychotics have gradually replaced first-generation antipsychotics as first-line treatment for patients with schizophrenia. Some positive effects on verbal cognition have been shown for the second-generation antipsychotics, but most studies are based on relatively small numbers of patients. OBJECTIVE In the frame of the prospective, multi-centre, open-label study ESCAPE (A Prospective, Multicenter, Open-Label Study to Evaluate the Effectiveness and the Effect on Cognitive Function of a Treatment With Aripiprazole in a Broad Range of Schizophrenic Patients; clinicaltrials.gov identifier NCT00329810) evaluating the effectiveness and effect on cognitive functioning of aripiprazole in schizophrenic patients, we conducted a post hoc analysis to examine changes in verbal cognition and investigate the predictive value of a cognitive improvement on quality of life. STUDY DESIGN This was a prospective, multi-centre, non-comparative, open-label study of aripiprazole in schizophrenic patients. At study enrolment, these patients were being treated with various first- or second-generation antipsychotics or were without previous antipsychotic treatment. On entering the study, all patients were treated with aripiprazole (Abilify(®); Otsuka, Tokyo, Japan) monotherapy; those patients who had received prior treatment with antipsychotics had their current drug(s) tapered off over a 2-week period. A post hoc analysis of the effect of aripiprazole on two verbal cognitive measures and their correlation with efficacy measures and quality of life was conducted. SETTING Patients with schizophrenia were recruited in 56 psychiatric hospitals. PATIENTS A total of 361 patients with schizophrenia, ranging from 18 to 65 years, entered the study. INTERVENTION Patients were treated with aripiprazole monotherapy at a dosage of 10-30 mg/day. Those who were receiving first- or second-generation antipsychotics at enrolment were switched to aripiprazole monotherapy by tapering off their current drug(s) over a 2-week period. MAIN OUTCOME MEASURE Physician- and patient-rated parameters were measured to gain a complete view of the effectiveness of aripiprazole on the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) at baseline and at weeks 4, 8 and 12 and on the Clinical Global Impression-Severity of Illness (CGI-S) scale at baseline and at weeks 1, 2, 4, 8 and 12. A secondary endpoint of verbal cognitive function was measured by the California Verbal Learning Test (CVLT) and the Verbal Fluency (VF) test at baseline and at weeks 4 and 12. The hypothesis of an improvement in verbal cognition and its predictive value on the quality of life was formulated during data collection. RESULTS 238 patients completed the study. A significant improvement in verbal cognition was observed from week 4 with the long term free recall (LTFR) in the CVLT over the scheduled visits in the trial (F(2,519) = 29.67, p < 0.0001). For the phonemic (letter) subtest of the VF test, patients scored significantly better at week 12 in comparison with baseline (F(2,519) = 3.57, p = 0.0289). There was no significant effect on the semantic (categories) subtest of the VF test (F(2,518) = 0.57, p = 0.5614). Improvement in CGI-S scores at a particular moment in time predicted improvement in LTFR scores at that same moment (F(1,519) = 38.38, p < 0.0001) and in the phonemic (F(1,519) = 42.77, p < 0.0001) and semantic (F(1,518) = 67.43, p < 0.0001) subtests of the VF test. Similarly, CGI-S score improvement globally predicted quality-of-life improvement over visits. The Q-LES-Q scales leisure (F(1,144) = 14.03, p < 0.0001) and social relations (F(1,469) = 5.28, p = 0.0220) also directly correlated with verbal cognition. CONCLUSION The findings suggest that switching to, or initiating aripiprazole in schizophrenic patients results in improvement in verbal cognitive functioning. The observed improvement on quality of life is explained by the effect of aripiprazole on the CGI-S score, though the leisure and social relations scales of the Q-LES-Q also independently correlated with verbal fluency. Randomized, controlled, clinical trials of this effect of aripiprazole for selected patients are needed.
Collapse
|
47
|
Tanioka T, Fuji S, Kataoka M, King B, Tomotake M, Yasuhara Y, Locsin R, Sekido K, Mifune K. Retrospective study of Japanese patients with schizophrenia treated with aripiprazole. ISRN NURSING 2012; 2012:454898. [PMID: 22970386 PMCID: PMC3437285 DOI: 10.5402/2012/454898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/05/2012] [Indexed: 11/23/2022]
Abstract
Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (P = 0.04), significant decrease in dosage of antipsychotics in 71% of patients (P = 0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (P = 0.07) and body mass index (BMI) (P = 0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (P = 0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL.
Collapse
Affiliation(s)
- Tetsuya Tanioka
- Department of Nursing, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8509, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|