Fast Versus Slow Strategy of Switching Patients With Schizophrenia to Aripiprazole From Other Antipsychotics.
This study aimed to compare strategies differing in the speed of switching schizophrenic patients to aripiprazole from other antipsychotic agents, with dual administration for 2 weeks and then tapering off the current antipsychotic in fast (within 1 week) versus slow (within 4 weeks) strategies. This 8-week, open-label, randomized, parallel study assigned patients with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia or schizoaffective disorder to either the fast-switching (n = 38) or slow-switching (n = 41) group. Efficacy assessments at 5 time points included Positive and Negative Syndrome Scale and Clinical Global Impression scale. Safety assessments included extrapyramidal symptoms, metabolic profile, serum prolactin level, QTc interval, and adverse events. Drug concentrations and cytochrome P450 CYP2D6 and CYP3A4 genotypes were also measured. The fast- and slow-switching groups were comparable in demographical and clinical features at baseline and dropout rate. In the intention-to-treat analysis using mixed-effects models, there were significant within-group decreases over time in the Positive and Negative Syndrome Scale total scores (P = 0.03) and its subscores except for positive subscores, whereas no between-group differences were found. A reduction in body weight (P = 0.01) and lower levels of total cholesterol (P = 0.03), triglycerides (P = 0.03), and prolactin (P = 0.01) were noted in both groups but no increase in extrapyramidal symptoms or prolongation of QTc. The blood concentrations of aripiprazole in all patients were in a therapeutic range at day 56, with CYP2D6*10 polymorphisms being associated with aripiprazole concentrations. In conclusion, there is no significant difference between the fast- and slow-switching strategy in terms of improvements in clinical symptoms and metabolic profile in this 8-week study.
From the *Department of Psychiatry, College of Medicine, National Taiwan University Hospital; †Institute of Epidemiology and Preventive Medicine, College of Public Health; ‡Taoyuan Mental Hospital, Taoyuan County; §School of Pharmacy, College of Medicine, National Taiwan University, Taipei; ||National Clinical Trial Statistical Center, Taipei, Taiwan.
Tzung-Jeng
TJ
Hwang
Wei-Ming
WM
Lo
Hung-Yu
HY
Chan
Ching-Feng
CF
Lin
Ming H
MH
Hsieh
Chen-Chun
CC
Liu
Chih-Min
CM
Liu
Hai-Gwo
HG
Hwu
Ching-Hua
CH
Kuo
Wei J
WJ
Chen
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D000068180:Aripiprazole / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000235:genetics; D012559:Schizophrenia / Q000188:drug therapy* / Q000235:genetics; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D000068180:Aripiprazole