Subjective attitude to risperidone long-acting injectable (RLAI): Results from a long-term Italian study in subjects with schizophrenia or schizoaffective disorder

IntroductionRecent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.ObjectiveWe present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.AimsTo study “oral AAP-LAIA combo” benefits in refractory SAFM cases.MethodsOur patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.ResultsWe maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.ConclusionsOral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Erratum: Relapse Prevention in Schizophrenia and Schizoaffective Disorder with Risperidone Long-Acting Injectable vs Quetiapine: Results of a Long-Term, Open-Label, Randomized Clinical Trial

Neuropsychopharmacology ◽

10.1038/npp.2010.206 ◽

2010 ◽

Vol 36 (2) ◽

pp. 548-548

Author(s):

Wolfgang Gaebel ◽

Andreas Schreiner ◽

Paul Bergmans ◽

Rosario de Arce ◽

Frédéric Rouillon ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Schizoaffective Disorder ◽

Relapse Prevention ◽

Open Label ◽

Long Acting

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Long-term Remission in Schizophrenia and Schizoaffective Disorder: Results from the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)

European Psychiatry ◽

10.1016/s0924-9338(09)71254-4 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

E. Smeraldi ◽

R. Cavallaro ◽

V. Folnegovic Smalc ◽

L. Bidzan ◽

E. Ceylan ◽

...

Keyword(s):

Adverse Events ◽

Schizoaffective Disorder ◽

Relapse Prevention ◽

Package Insert ◽

Prevention Trial ◽

Treatment Groups ◽

Conventional Antipsychotics ◽

Full Remission ◽

Long Acting

Objective:To report the long-term remission results from the relapse prevention trial (ConstaTRE) in stable patients treated either with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.Methods:Clinically stable adults with schizophrenia or schizoaffective disorder treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with RLAI or oral quetiapine. Dosing was according to package-insert recommendation. Efficacy and tolerability were recorded for up to 24 months of treatment. Remission was defined as achieving and maintaining mild or less symptoms of schizophrenia over a 6-month period as defined by Andreasen et al, (2005).Results:710 patients were randomized (n=355 per group) to either RLAI or quetiapine. Demographics were similar between treatment groups. Relapse occurred in 54 RLAI (16.5%) and 102 quetiapine (31.3%) patients (p< 0.001). Full remission was achieved by 51% RLAI and 39% of quetiapine-treated patients (p=0.003) and was maintained until the end of the trial by 44% of RLAI and 31% of quetiapine patients. Mean duration of full remission was 540.8±181.4 and 508.1±188.0 days for RLAI and quetiapine groups, respectively (p=0.1325). Tolerability was similar between treatment groups. Most adverse events (AEs) were transient. Six RLAI and 10 quetiapine patients discontinued study treatment due to AEs.Conclusions:Among stable patients with schizophrenia or schizoaffective disorder, remission was more likely to occur in patients switching to RLAI when compared with quetiapine. both RLAI and quetiapine treatments were well tolerated.

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