TY - JOUR
T1 - Antipsychotic switching versus augmentation among early non-responders to risperidone or olanzapine in acute-phase schizophrenia
AU - Hatta, Kotaro
AU - Otachi, Taro
AU - Fujita, Kiyoshi
AU - Morikawa, Fumiyoshi
AU - Ito, Shin
AU - Tomiyama, Hirofumi
AU - Abe, Takayuki
AU - Sudo, Yasuhiko
AU - Takebayashi, Hiroshi
AU - Yamashita, Toru
AU - Katayama, Shigemasa
AU - Nakase, Reiko
AU - Shirai, Yutaka
AU - Usui, Chie
AU - Nakamura, Hiroyuki
AU - Ito, Hiroto
AU - Hirata, Toyoaki
AU - Sawa, Yutaka
N1 - Funding Information:
This work was supported by grants from the Ministry of Health, Welfare, and Labor of the Japanese Government (Comprehensive Research on Disability Health and Welfare, H23-008), and Intramural Research Grant for Neurological and Psychiatric Disorders of NCNP, 26-10. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, and the decision to submit the paper for publication.
PY - 2014
Y1 - 2014
N2 - Purpose: We examined whether augmentation with olanzapine would be superior to switching to olanzapine among early non-responders (ENRs) to risperidone, and whether augmentation with risperidone would be superior to switching to risperidone among ENRs to olanzapine.We performed a rater-blinded, randomized clinical trial at psychiatric emergency sites. Eligible patients were newly admitted patients with acute schizophrenia. ENRs to the initial antipsychotic (Clinical Global Impressions-Improvement Scale: ≥. 4 at 2. weeks) were allocated to receive either augmentation with or switching to the other antipsychotic (RIS. +. OLZ vs. RIS-OLZ; OLZ. +. RIS vs. OLZ-RIS). Results: Sixty patients who completed 2. weeks of risperidone treatment were divided into 33 early responders (RIS-ER) and 27 ENRs (RIS. +. OLZ, n. =. 14; RIS-OLZ, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in RIS. +. OLZ group (54.1. days [95% confidence interval, 41.3-67.0]) than in RIS-ER group (68.7 [61.2-76.2]; P=. 0.050), it was not significantly shorter in RIS-OLZ group (58.5 [43.1-73.9]) than in RIS-ER group (P=. 0.19). Sixty patients who completed 2. weeks of olanzapine treatment were divided into 36 early responders (OLZ-ER) and 24 ENRs (OLZ. +. RIS, n. =. 11; OLZ-RIS, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in OLZ-RIS group (56.1. days [40.7-71.5]) than in OLZ-ER group (74.9 [68.5-81.3]; P=. 0.008), it was not significantly shorter in OLZ. +. RIS group (64.6 [49.6-79.6]) than in OLZ-ER group (P=. 0.20). Conclusion: Despite the lack of pharmacokinetic investigation of dose adequacy in this study, it is possible that switching to olanzapine among ENRs to risperidone might have a small advantage over augmentation with olanzapine, while augmentation with risperidone might have a small advantage over switching to risperidone among ENRs to olanzapine. Further research is required before it would be appropriate to modify routine practice in the direction of these findings.
AB - Purpose: We examined whether augmentation with olanzapine would be superior to switching to olanzapine among early non-responders (ENRs) to risperidone, and whether augmentation with risperidone would be superior to switching to risperidone among ENRs to olanzapine.We performed a rater-blinded, randomized clinical trial at psychiatric emergency sites. Eligible patients were newly admitted patients with acute schizophrenia. ENRs to the initial antipsychotic (Clinical Global Impressions-Improvement Scale: ≥. 4 at 2. weeks) were allocated to receive either augmentation with or switching to the other antipsychotic (RIS. +. OLZ vs. RIS-OLZ; OLZ. +. RIS vs. OLZ-RIS). Results: Sixty patients who completed 2. weeks of risperidone treatment were divided into 33 early responders (RIS-ER) and 27 ENRs (RIS. +. OLZ, n. =. 14; RIS-OLZ, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in RIS. +. OLZ group (54.1. days [95% confidence interval, 41.3-67.0]) than in RIS-ER group (68.7 [61.2-76.2]; P=. 0.050), it was not significantly shorter in RIS-OLZ group (58.5 [43.1-73.9]) than in RIS-ER group (P=. 0.19). Sixty patients who completed 2. weeks of olanzapine treatment were divided into 36 early responders (OLZ-ER) and 24 ENRs (OLZ. +. RIS, n. =. 11; OLZ-RIS, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in OLZ-RIS group (56.1. days [40.7-71.5]) than in OLZ-ER group (74.9 [68.5-81.3]; P=. 0.008), it was not significantly shorter in OLZ. +. RIS group (64.6 [49.6-79.6]) than in OLZ-ER group (P=. 0.20). Conclusion: Despite the lack of pharmacokinetic investigation of dose adequacy in this study, it is possible that switching to olanzapine among ENRs to risperidone might have a small advantage over augmentation with olanzapine, while augmentation with risperidone might have a small advantage over switching to risperidone among ENRs to olanzapine. Further research is required before it would be appropriate to modify routine practice in the direction of these findings.
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U2 - 10.1016/j.schres.2014.07.015
DO - 10.1016/j.schres.2014.07.015
M3 - Article
C2 - 25086659
AN - SCOPUS:84906938642
VL - 158
SP - 213
EP - 222
JO - Schizophrenia Research
JF - Schizophrenia Research
SN - 0920-9964
IS - 1-3
ER -
