A fast strategy in switching chronic schizophrenia patients to aripiprazole from other antipsychotics, as compared with a slow-switching strategy, has equivalent efficacy in terms of improving negative symptoms and metabolic function without worsening positive symptoms or other side effects in the first 8 weeks, according to a new study by researchers at National Taiwan University (NTU). This study has been published in the December issue of Journal of Clinical Psychopharmacology.
Despite many advantageous properties of atypical antipsychotics in treating patients with schizophrenia, they still have adverse events such as metabolic syndrome, hyperprolactinemia, and QTc interval prolongation, which result in other health problems and poor drug adherence. According to first author Dr. Tzung-Jeng Hwang, a PhD graduate of Institute of Epidemiology and Preventive Medicine at NTU and currently assistant professor in the department of psychiatry at NTU Hospital, “National data in Taiwan indicated that about one third of the patients with schizophrenia have metabolic syndrome or diabetes, with several types of antipsychotics being implicated as the causative agents.”
This eight-week, open-label, randomized, multi-site clinical trial was conducted at National Taiwan University Hospital, Taoyuan Psychiatric Center, and Ju-Shan Hospital. Patients with a primary diagnosis of schizophrenia or schizoaffective disorder received dual administration for 2 weeks and then were tapering off the current antipsychotic either within one week (the fast-switching strategy, n = 38) or within four weeks (the slow-switching strategy, n = 41). Comprehensive measurements at multiple time points were made, including clinical symptoms, metabolic function, and drug concentrations, as well as cytochrome metabolism genotype profiles.
It turns out that the fast-switching strategy had equivalent efficacy in terms of reducing negative symptoms, general psychopathology, and total PANSS scores along with comparable improvements in metabolic function, but with no detectable worsening in positive symptoms or other side effects in the first 8 weeks compared with the slow-switching strategy. “These findings have important implications for the clinical management of chronic schizophrenia patients,” said Dr. Wei J. Chen, the corresponding author of this paper and currently Dean of College of Public Health at NTU.
“One important implication of the study is that the fast-switching (as short as one week) is comparable to the slow-switching (one month or more) strategy in switching chronic schizophrenia patients to aripiprazole from other antipsychotics in terms of efficacy and side-effects,” the authors write. “This is in contrast to the usual recommendations by experts that slower switching is the preferred approach. These recommendations are not firmly supported by current evidence and more research is warranted before a solid conclusion can be made.”