Comparison of treatment response of typical and atypical antipsychotics in acute mania

IntroductionThe medical treatment of acute mania today mainly includes atypical and typical antipsychotics, lithium or valproat. Atypical antipsychotics are often used as first-line treatment, while typical antipsychotics come with the risk of severe long-term side effects and less used today. However, typical antipsychotics may lead to a faster reduction in the severity of mania or a faster remission of symptoms.ObjectiveTo investigate whether the acute effect of typical antipsychotics differs from atypical antipsychotics measured by a daily mania rating-scale (MAS-M) and duration of treatment in a real-life clinical setting.AimTo help determine if short-term treatment with typical antipsychotics may still be of benefit in the acute treatment of mania.MethodsThis is a retrospective case record study. Patients admitted to an acute hospital ward with acute mania between 2012 and 2015 were included (n = 100). The daily use of atypical and typical antipsychotics will be compared by daily change in Bech-Rafaelsen Modified Mania Scale (Mas-M) score and time to discharge. The change in mania over time is presented visually using graph curves.ResultsThe data extraction and data handling will be executed in the winter 2015–2016.ConclusionsAny preliminary findings will be presented at EPA 2016.

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Typical and Atypical Antipsychotics in Acute Mania: Comparison of Effectiveness

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2169 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S207-S208

Author(s):

C.R. Medici ◽

L.M. Kai ◽

S.B. Kristensen ◽

C. Kirkedal ◽

S.P.V. Straszek

Keyword(s):

Atypical Antipsychotics ◽

Mixed Model ◽

Hospital Admissions ◽

University Hospital ◽

World Health ◽

Defined Daily Dose ◽

Retrospective Case ◽

Case Record ◽

Typical And Atypical Antipsychotics ◽

Typical Antipsychotics

IntroductionMania is challenging to treat. Typical antipsychotics may be more efficient compared with atypical antipsychotics, however, with unfavourable side effects.ObjectivesTo help the clinician choose between typical and atypical antipsychotics.AimsTo investigate the correlation between change in severity of mania and the corresponding day to day use of typical and atypical antipsychotics.MethodsThis retrospective case record study included patients admitted with mania (International Classification of Diseases 10th revision code F30, F31.0, F31.1, F31.2 or F31.6) at the Department of Affective Disorders, Aarhus University Hospital, Denmark, between January 2013, and December 2015. The dose of typical and atypical antipsychotics was standardized as defined daily dose according to the World Health Organization's guidelines. The severity of mania was measured daily with the Modified Bech-Rafaelsen Mania Scale (MAS-M), a validated, nurse administered scale (MAS-M). We applied a linear regression in a mixed model approach to compare the Mas-M score over time under the influence of typical and atypical antipsychotics, respectively, adjusted for baseline characteristics.ResultsWe included 43 patients. Patients receiving typical antipsychotics had more recent hospital admissions, a higher dosage antipsychotics and more constraint. The baseline MAS-M score was higher in patients receiving typical antipsychotics. The daily change in MAS-M score was–0.25 for typical antipsychotics and–0.23 for atypical antipsychotics with a difference of 0.02 (95% CI 0.008–0.039).ConclusionsThe rate of improvement of mania may be independent of baseline illness or type of antipsychotic medication. This may be confounded by indication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Review of the efficacy of placebo in comparative clinical trials between typical and atypical antipsychotics

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462009000100013 ◽

2009 ◽

Vol 31 (1) ◽

pp. 52-56 ◽

Cited By ~ 5

Author(s):

Irismar Reis de Oliveira ◽

Paulo Menezes Nunes ◽

Domingos Macedo Coutinho ◽

Eduardo Pondé de Sena

Keyword(s):

Clinical Trials ◽

Atypical Antipsychotic ◽

Atypical Antipsychotics ◽

Rating Scale ◽

Study Drug ◽

Typical Antipsychotic ◽

The Difference ◽

Psychiatric Rating Scale ◽

Efficacy Parameters ◽

Typical Antipsychotics

OBJECTIVE: To review the efficacy of placebo in comparison with atypical and typical antipsychotics for the treatment of schizophrenia and schizoaffective disorder and to evaluate the pertinence of using placebo in clinical trials with antipsychotics. METHOD: Trials in which the atypical antipsychotics were compared with typical antipsychotics and placebo were included. A search was conducted using the terms "amisulpride", "aripiprazole", "clozapine", "olanzapine", "quetiapine", "risperidone", "sertindole", "ziprasidone" and "zotepine". Main efficacy parameters were calculated using the proportion of "events" (defined as a deterioration or lack of improvement by at least 20% in Positive and Negative Syndrome Scale or Brief Psychiatric Rating Scale) and the pooled relative risk with random effects, with their respective 95% confidence intervals. We also calculated the necessary sample sizes in studies in which the study drug is compared to a typical antipsychotic or placebo. RESULTS: The pooled efficacy rates observed were 40.8%, 34.9% and 21.3% for the atypical antipsychotics, typical antipsychotics and placebo, respectively. One hundred and sixty six patients would have to be included when a new drug is compared with placebo if calculation is based on a difference of 20% found between the atypical antipsychotic and placebo and 2,054 if the difference sought were that found between the atypical antipsychotic and the typical antipsychotic, i.e. 6%. The estimated therapeutic failures would be 115 of the 166 patients when the study drug is compared with placebo, and 1,274 failures in the 2,054 patients when the study drug is compared to the typical antipsychotic. CONCLUSIONS: Placebo controlled studies may reduce the number of individuals exposed to the harmful effects of ineffective drugs.

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Use of Atypical Antipsychotics on an As-Needed Basis

Journal of Pharmacy Technology ◽

10.1177/875512259601200407 ◽

1996 ◽

Vol 12 (4) ◽

pp. 145-148 ◽

Cited By ~ 5

Author(s):

Dorothy Demczar ◽

Gary M Levin

Keyword(s):

English Language ◽

Atypical Antipsychotics ◽

Data Extraction ◽

Cost Effective ◽

Antipsychotic Agents ◽

Therapeutic Benefit ◽

Pharmacokinetic Parameters ◽

Typical Antipsychotic ◽

Medline Search ◽

Typical Antipsychotics

Objective: To review the literature and determine whether atypical antipsychotics should be used on an as-needed (prn) basis. Data Sources: Pertinent English-language literature dealing with atypical antipsychotics, typical antipsychotics, phamacokinetics, and prn dosing strategies was retrieved from a MEDLINE search (1960–1995). Data Extraction: Articles that discussed either pharmacokinetic parameters or the rationale for using antipsychotics on a prn basis. Data Synthesis: Administration of typical antipsychotics on a prn basis, either alone or in combination with scheduled antipsychotics, is a common practice. However, it has recently been recognized that the atypical agents, clozapine and risperidone, are also being prescribed for prn dosing. Clozapine has a sedative component that may provide a therapeutic benefit when prescribed prn, but it is also associated with dose-related seizures and orthostatic hypotension. Risperidone does not appear to exhibit sedation, except at very high doses. Conclusions: The risk-to-benefit ratio is not acceptable in using the atypical antipsychotic agents on a prn basis. There are documented safety and efficacy data that support the use of the typical antipsychotic agents such as chlorpromazine, or haloperidol in combination with lorazepam, on a prn basis. These latter choices are also more cost-effective.

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Cost-effectiveness of Antipsychotics in Treatment of Schizophrenia Patients admitted to a secondary Hospital

Indonesian Journal of Pharmaceutical and Clinical Research ◽

10.32734/idjpcr.v2i2.454 ◽

2019 ◽

Vol 2 (2) ◽

pp. 43-52

Author(s):

Yuni Andriani ◽

Frisca Nindy Septiani ◽

Defirson Defirson

Keyword(s):

Cost Effectiveness ◽

Atypical Antipsychotics ◽

Antipsychotic Drugs ◽

Length Of Hospital Stay ◽

Sampling Technique ◽

Cost Effective ◽

Treatment Costs ◽

Typical Antipsychotic ◽

Duration Of Treatment ◽

Typical Antipsychotics

Abstract. Schizophrenia is a chronic disease that requires relatively high treatment costs [1]. Several studies have found that atypical antipsychotics are more effective compared to typical antipsychotics. As a result, the duration of treatment and the patients’ length of hospital stay will be shorter which ultimately reduce the overall treatment costs. Therefore, it is necessary to conduct a cost-effectiveness analysis (CEA) of the two classes of antipsychotic drugs in the treatment of schizophrenia inpatients admitted to Jambi Province Hospital period 2013-2016. Method: This descriptive retrospective cohort study was undertaken to analyze cost-effectiveness of the antipsychotic drugs provided to patients with schizophrenia (n=910) admitted to Jambi Province Hospital from the perspective of a healthcare provider. using purposive sampling technique. Characteristics of the patients, antipsychotic drugs usage, costs consumed, and treatment outcome were extracted from the hospital databases. Results: It was found that the total ACER value of the typical antipsychotic group was Rp. 142,789.25 and atypical antipsychotics is IDR 163,045.50 which indicates that the typical ACER antipsychotic value is smaller than those of atypical antipsychotics based on the length of stay of patients in the Psychiatric Intensive Care Unit (PICU) room. Whereas based on the PANSS-EC score of the patient, the total ACER value of the typical antipsychotic group was IDR1,189,910.42 and in atypical antipsychotics was IDR. 572,089.47. Conclusion: Atypical antipsychotics are more cost-effective than typical antipsychotics.

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Real Life Rating Scale

PsycTESTS Dataset ◽

10.1037/t04000-000 ◽

1986 ◽

Author(s):

B. J. Freeman ◽

Edward R. Ritvo ◽

Alice Yokota ◽

Anne Ritvo

Keyword(s):

Rating Scale ◽

Real Life

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Typical and Atypical Antipsychotics in Acute Mania: Comparison of Effectiveness

10.26226/morressier.5885d719d462b8028d891d95 ◽

2017 ◽

Author(s):

Clara Reece Medici

Keyword(s):

Atypical Antipsychotics ◽

Acute Mania ◽

Comparison Of Effectiveness ◽

Typical And Atypical Antipsychotics

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Cerliponase Alfa for the Treatment of Atypical Phenotypes of CLN2 Disease: A Retrospective Case Series

Journal of Child Neurology ◽

10.1177/0883073820977997 ◽

2020 ◽

pp. 088307382097799

Author(s):

Eva Wibbeler ◽

Raymond Wang ◽

Emily de los Reyes ◽

Nicola Specchio ◽

Paul Gissen ◽

...

Keyword(s):

Treatment Duration ◽

Chart Review ◽

Rating Scale ◽

Neuronal Ceroid Lipofuscinosis ◽

Case Series ◽

Language Function ◽

Retrospective Case ◽

Function Loss ◽

Clinical Rating Scale

Background: The classic phenotype of CLN2 disease (neuronal ceroid lipofuscinosis type 2) typically manifests between ages 2 and 4 years with a predictable clinical course marked by epilepsy, language developmental delay, and rapid psychomotor decline. Atypical phenotypes exhibit variable time of onset, symptomatology, and/or progression. Intracerebroventricular-administered cerliponase alfa (rhTPP1 enzyme) has been shown to stabilize motor and language function loss in patients with classic CLN2 disease, but its impact on individuals with atypical phenotypes has not been described. Methods: A chart review was conducted of 14 patients (8 male, 6 female) with atypical CLN2 phenotypes who received cerliponase alfa. Pre- and posttreatment CLN2 Clinical Rating Scale Motor and Language (ML) domain scores were compared. Results: Median age at first presenting symptom was 5.9 years. First reported symptoms were language abnormalities (6 [43%] patients), seizures (4 [29%]), ataxia/language abnormalities (3 [21%]), and ataxia alone (1 [7%]). Median age at diagnosis was 10.8 years. ML score declined before treatment in 13 (93%) patients. Median age at treatment initiation was 11.7 years; treatment duration ranged from 11 to 58 months. From treatment start, ML score remained stable in 11 patients (treatment duration 11-43 months), improved 1 point in 1 patient after 13 months, and declined 1 point in 2 patients after 15 and 58 months, respectively. There were 13 device-related infections in 8 patients (57%) and 10 hypersensitivity reactions in 6 (43%). Conclusions: Cerliponase alfa is well tolerated and has the potential to stabilize motor and language function in patients with atypical phenotypes of CLN2 disease.

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Lorlatinib in pretreated ALK- or ROS1-positive lung cancer and impact of TP53 co-mutations: results from the German early access program

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920980558 ◽

2021 ◽

Vol 13 ◽

pp. 175883592098055 ◽

Cited By ~ 1

Author(s):

Nikolaj Frost ◽

Petros Christopoulos ◽

Diego Kauffmann-Guerrero ◽

Jan Stratmann ◽

Richard Riedel ◽

...

Keyword(s):

Treatment Failure ◽

Survival Rates ◽

Real Life ◽

Progression Free Survival ◽

Leptomeningeal Carcinomatosis ◽

Resistance Mutations ◽

Duration Of Treatment ◽

Tp53 Mutations ◽

Early Access ◽

Access Program

Introduction: We report on the results of the German early access program (EAP) with the third-generation ALK- and ROS1-inhibitor lorlatinib. Patients and Methods: Patients with documented treatment failure of all approved ALK/ROS1-specific therapies or with resistance mutations not covered by approved inhibitors or leptomeningeal carcinomatosis were enrolled and analyzed. Results: In total, 52 patients were included [median age 57 years (range 32–81), 54% female, 62% never smokers, 98% adenocarcinoma]; 71% and 29% were ALK- and ROS1-positive, respectively. G1202R and G2032R resistance mutations prior to treatment with lorlatinib were observed in 10 of 26 evaluable patients (39%), 11 of 39 patients showed TP53 mutations (28%). Thirty-six patients (69%) had active brain metastases (BM) and nine (17%) leptomeningeal carcinomatosis when entering the EAP. Median number of prior specific TKIs was 3 (range 1–4). Median duration of treatment, progression-free survival (PFS), response rate and time to treatment failure were 10.4 months, 8.0 months, 54% and 13.0 months. Calculated 12-, 18- and 24-months survival rates were 65, 54 and 47%, overall survival since primary diagnosis (OS2) reached 79.6 months. TP53 mutations were associated with a substantially reduced PFS (3.7 versus 10.8 month, HR 3.3, p = 0.003) and were also identified as a strong prognostic biomarker (HR for OS2 3.0 p = 0.02). Neither prior treatments with second-generation TKIs nor BM had a significant influence on PFS and OS. Conclusions: Our data from real-life practice demonstrate the efficacy of lorlatinib in mostly heavily pretreated patients, providing a clinically meaningful option for patients with resistance mutations not covered by other targeted therapies and those with BM or leptomeningeal carcinomatosis.

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Real Life Use of Bendamustine in Elderly Patients with Lymphoid Neoplasia

Journal of Personalized Medicine ◽

10.3390/jpm11040249 ◽

2021 ◽

Vol 11 (4) ◽

pp. 249

Author(s):

Irene Dogliotti ◽

Simone Ragaini ◽

Francesco Vassallo ◽

Elia Boccellato ◽

Gabriele De Luca ◽

...

Keyword(s):

Elderly Patients ◽

Rating Scale ◽

Single Agent ◽

Multivariable Analysis ◽

Real Life ◽

Lymphocytic Leukemia ◽

Factors Affecting ◽

Lymphoid Neoplasia ◽

Baseline Factors ◽

Grade 3

Background. Bendamustine is a cytotoxic alkylating drug with a broad range of indications as a single agent or in combination therapy in lymphoid neoplasia patients. However, its tolerability in elderly patients is still debated. Methods: An observational, retrospective study was carried out; patients with chronic lymphocytic leukemia (CLL) or lymphoma, aged ≥ 65 years old, treated with bendamustine-based regimens in first or subsequent lines between 2010 and 2020 were considered eligible. Results: Overall, 179 patients aged ≥ 65 years were enrolled, 53% between 71 and 79 years old. Cumulative Illness Rating Scale (CIRS) comorbidity score was ≥6 in 54% patients. Overall survival (OS) at 12 months was 95% (95% confidence interval [CI]: 90–97%); after a median follow up of 50 months, median OS was 84 months. The overall response rate was 87%, with 56% complete responses; the median time to progression (TTP) was 61 months. The baseline factors affecting OS by multivariable analysis were sex, histological diagnosis, renal function, and planned bendamustine dose, while only type of lymphoma and bendamustine dose impacted on TTP. Main adverse events were neutropenia (grade ≥ 3: 43%) and infections (any grade: 36%), with 17% of patients requiring hospital admission. Conclusions: The responses to bendamustine, as well as survival, are relevant even in advanced age patients, with a manageable incidence of acute toxicity.

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