Establishing remission and good clinical functioning in schizophrenia: predictors of best outcome with long-term risperidone long-acting injectable treatment.
OBJECTIVE
To measure symptomatic and functional remission in patients treated with risperidone long-acting injectable (RLAI).


METHODS
Stable patients with psychotic disorders requiring medication change were switched to open-label RLAI in the switch to risperidone microspheres (StoRMi) trial. In this post-hoc analysis of the trial extension, follow-up was <or=18 months. Symptomatic remission was based on improvement in positive and negative syndrome scale (PANSS) scores and global remission (best outcome) was based on symptomatic remission, functional level, and mental-health quality of life. Predictive factors were evaluated.


RESULTS
Among 529 patients from seven European countries, mean participation duration was 358.7+/-232.4 days, with 18 months completed by 39.9% of patients. Symptomatic remission lasting >or=6 months occurred at some point during treatment in 33% of patients; predictors included comorbid disease, country, baseline symptom severity, baseline functioning, type of antipsychotic before switching, and duration of untreated psychosis. Best outcome occurred in 21% of patients; predictors included baseline symptom severity, baseline functioning, country, schizophrenia type, and early positive treatment course.


CONCLUSIONS
One in three patients with stable schizophrenia switching to RLAI experienced symptomatic remission, with combined symptomatic, functional, and quality-of-life remission in one in five patients. Symptomatic remission was predicted by better baseline symptom severity and country of origin, with a significantly greater likelihood of remission occurring among patients in Estonia/Slovenia compared with Portugal. Relapse was predicted by higher mode doses of RLAI, additional use of psychoactive medications, male gender, and country of origin, with relapse occurring most frequently in France and least frequently in Portugal. RLAI dose, additional use of psychoactive medications, and country of origin predicted best outcome, with best outcome occurring most frequently in Estonia/Slovenia and least frequently in Portugal.
Lambert
M
M
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf Hamburg, Martinistreet 52, 20246 Hamburg, Germany. lambert@uke.de
De Marinis
T
T
Pfeil
J
J
Naber
D
D
Schreiner
A
A
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D004957:Estonia; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012074:Remission Induction; D018967:Risperidone / Q000008:administration & dosage*; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D017524:Slovenia; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone