title: Persistence in Therapy With Risperidone and Aripiprazole in Pediatric Outpatients: A 2-Year Naturalistic Comparison.
abstract: OBJECTIVE
  The practical effectiveness of second-generation antipsychotics in children and adolescents is an understudied issue. It is a crucial area of study, though, because such patients are often treated for long-lasting disorders.
  
  
  METHODS
  We carried out a 24-month (March 2012-March 2014) observational study on an unselected population of pediatric outpatients treated with risperidone, aripiprazole, olanzapine, or quetiapine aiming to (1) describe drug use, (2) compare post hoc the discontinuation rates due to specific causes and dose adjustments by Kaplan-Meier analyses between drugs, and (3) analyze predictors influencing these outcomes by Cox multivariate models.
  
  
  RESULTS
  Among 184 pediatric patients, 77% patients were prescribed risperidone, and 18% were prescribed aripiprazole. Olanzapine or quetiapine were scantly used; therefore, they were excluded from analyses. Risperidone was prevalent in younger, male patients with disruptive behavioral disorders; aripiprazole, in patients with tic disorders. Overall, discontinuations occurred mostly in the first 6 months, and, at 24 months, the discontinuation numbers were similar between users of risperidone and aripiprazole (41.5% vs 39.4%). In univariate analyses, dose reduction was higher for aripiprazole (P = .033). Multivariate analyses yielded the following predictors: for all-cause discontinuation, baseline severity (hazard ratio [HR] = 1.48, P = .001) and dose increase (HR = 3.55, P = .001); for patient-decided discontinuation, dose change (increase: HR = 6.43, P = .004; reduction: HR = 7.89, P = .049) and the presence of concomitant drugs (HR = 4.03, P = .034), while autistic patients discontinued less (HR = 0.23, P = .050); for clinician-decided discontinuation due to adverse drug reactions, baseline severity (HR = 1.96, P = .005) and dose increase (HR = 5.09, P = .016); for clinician-decided discontinuation due to inefficacy, baseline severity (HR = 2.88, P = .014) and the use of aripiprazole (HR = 5.55, P = .013); for dose increase, none; for dose reduction, the occurrence of adverse drug reactions (HR = 4.74, P = .046), while dose reduction was less probable in autistic patients (HR = 0.22, P = .042).
  
  
  CONCLUSIONS
  The findings of this study show a similarity between the overall effectiveness of risperidone and aripiprazole in a real-life pediatric outpatient setting.
authors: Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
authors: Marco
authors: M
authors: Pozzi
authors: Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy.
authors: Simone
authors: S
authors: Pisano
authors: Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
authors: Silvana
authors: S
authors: Bertella
authors: Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy.
authors: Annalisa
authors: A
authors: Capuano
authors: Child and Adolescent Neuropsychiatry, Department of Medical and Pediatric Sciences, School of Medicine, University of Catania, Italy.
authors: Renata
authors: R
authors: Rizzo
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.
authors: Stefania
authors: S
authors: Antoniazzi
authors: Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy.
authors: Fabiana
authors: F
authors: Auricchio
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.
authors: Carla
authors: C
authors: Carnovale
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.
authors: Dario
authors: D
authors: Cattaneo
authors: Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy.
authors: Carmen
authors: C
authors: Ferrajolo
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.
authors: Marta
authors: M
authors: Gentili
authors: Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Italy.
authors: Giuseppe
authors: G
authors: Guastella
authors: Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
authors: Elisa
authors: E
authors: Mani
authors: Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy.
authors: Concetta
authors: C
authors: Rafaniello
authors: Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy.
authors: Maria Pia
authors: MP
authors: Riccio
authors: Child and Adolescent Neuropsychiatry, Department of Medical and Pediatric Sciences, School of Medicine, University of Catania, Italy.
authors: Maria Grazia
authors: MG
authors: Scuderi
authors: Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy.
authors: Serena
authors: S
authors: Sperandeo
authors: Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy.
authors: Liberata
authors: L
authors: Sportiello
authors: Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
authors: Laura
authors: L
authors: Villa
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.
authors: Sonia
authors: S
authors: Radice
authors: Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Via GB Grassi 74, 20157 Milan, Italy. emilio.clementi@unimi.it.|Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.|Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.
authors: Emilio
authors: E
authors: Clementi
authors: Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy.
authors: Francesco
authors: F
authors: Rossi
authors: Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy.
authors: Antonio
authors: A
authors: Pascotto
authors: Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Italy.
authors: Renato
authors: R
authors: Bernardini
authors: Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
authors: Massimo
authors: M
authors: Molteni
authors: Department of Translational Medical Sciences, University Federico II of Naples, Italy.
authors: Carmela
authors: C
authors: Bravaccio
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000068180:Aripiprazole / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D012737:Sex Factors; D013981:Tic Disorders / Q000188:drug therapy*; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents; D000068180:Aripiprazole; D018967:Risperidone