Antipsychotic switching in schizoaffective disorder: A systematic review.
OBJECTIVE
To systematically review the evidence about the switching of antipsychotics in SZA in acute and maintenance treatment.


METHODS
A systematic review following the PRISMA statement identifying studies specifically conducted on, or including, SZA patients.


RESULTS
One analysis considered uniquely a SZA population, 13 more studies including an adequate SZA subsample were considered. Most of the studies were aimed at switching antipsychotic treatments to improve tolerability issues. Despite the absolute lack of trials specifically conducted on SZA populations, we found limited evidence on the use of aripiprazole, lurasidone, and, to a lesser extent, risperidone and ziprasidone as possible agents to substitute previous treatments whereas efficacy or, more frequently, tolerability issues arise. Evidence supports also the switch to risperidone long-acting injectable when the adherence to oral treatment may be a concern.


CONCLUSIONS
Antipsychotic switching in SZA is a neglected topic that would need better profiling. Clinicians should keep in mind the receptor binding characteristics of drugs in order to optimize transitions. Evidence supports the switch to aripiprazole and lurasidone, less strongly to risperidone and ziprasidone. The switch to risperidone long-acting injectable is supported, especially in patients with limited treatment adherence to oral therapy.
a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona , IDIBAPS, CIBERSAM, Barcelona , Catalonia , Spain.
Andrea
A
Murru
a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona , IDIBAPS, CIBERSAM, Barcelona , Catalonia , Spain.
Diego
D
Hidalgo
b Barcelona Clinic, Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM , Barcelona , Catalonia , Spain.
Miquel
M
Bernardo
c Área de Psiquiatría, Departamento de Medicina, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Oviedo , Asturias , España.
Julio
J
Bobes
d Servicio de Psiquiatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Madrid , Spain.
Jerónimo
J
Saiz-Ruiz
e Instituto de Neurociencias, Centro de Investigaciones Biomédicas (CIBM), Universidad de Granada , Granada , Spain.
Cecilio
C
Álamo
a Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona , IDIBAPS, CIBERSAM, Barcelona , Catalonia , Spain.
Eduard
E
Vieta
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000009:adverse effects / Q000627:therapeutic use*; D057915:Drug Substitution; D006801:Humans; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone; D000068180:Aripiprazole; D018967:Risperidone
PRISMA statement; antipsychotics; schizoaffective disorder; switching strategy; systematic review