A controlled, mirror-image study of second-generation antipsychotics in the treatment of schizophrenia

While some second-generation antipsychotics have shown efficacy on patients with borderline personality disorder (BPD), limited data exist regarding the effect of clozapine. Thus, we aimed to investigate the effects of clozapine on naturalistic outcomes in BPD patients with a 2-year mirror-image model. Among 25,916 patients with BPD, 1,107 redeemed ≥ 1 clozapine prescription. Of these, 18,188 were “specific” BPD patients, and 102 redeemed ≥ 1 clozapine prescription. During a mean observation period of 598.51 days, in all BPD patients, clozapine was associated with a significant reduction in psychiatric admissions from 2.52 (95‥ CI [2.31, 2.78]) to 2.00 (95‥ CI [1.77, 2.23]) admissions (p < .001) and a significant reduction in psychiatric bed-days from 190.08 (95‥ CI [176.84, 203.33]) to 65.95 (95‥ CI [58.27, 73.66]) bed-days (p < .001). Similar findings were found for “specific” BPD patients. The number of patients with intentional self-harm or overdose decreased significantly from 189 to 114 individuals (p < .001) after clozapine initiation. Randomized trials evaluating the risk- benefit ratio of clozapine in patients with severe BPD are warranted.

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A two-year mirror-image study of the effect of treatment with paliperidone and aripiprazole long-acting injections on need for inpatient care and home treatment intervention

BJPsych Open ◽

10.1192/bjo.2021.745 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S280-S280

Author(s):

Shay-Anne Pantall ◽

Joseph Pilsbury ◽

Le Gan ◽

Lisa Brownell

Keyword(s):

First Generation ◽

Second Generation ◽

Drug Acquisition ◽

Mirror Image ◽

Home Treatment ◽

Image Study ◽

Acquisition Costs ◽

Bed Days ◽

Long Acting ◽

Depot Antipsychotics

AimsTo evaluate the effect of the use of aripiprazole and paliperidone long acting injections on healthcare resource useBackgroundLong acting injections of second-generation antipsychotics such as paliperidone and aripiprazole have become more commonly prescribed over the past decade. They have much higher acquisition costs when compared to first generation depot antipsychotics. It is therefore essential to demonstrate their tolerability and cost-effectiveness.MethodWe undertook an observational, retrospective two-year mirror study for all patients who started treatment with paliperidone long acting injection between January and June 2016 (n = 47) or aripiprazole long acting injection between April 2014 and July 2017 (n = 93). Clinical notes were examined to determine the number of admissions, inpatient days, home treatment episodes and number of home treatment days, in the 12 months preceding and following the commencement of the long acting injection.Result70% remained on paliperidone and 62% remained on aripiprazole at the end of the one-year period.There was a significant reduction in occupied bed days in those treated with paliperidone from 78.2 days in the year before this treatment was started to 25.4 days in the year after (p = 0.002). There was a significant reduction in occupied bed days in those treated with aripiprazole from 66.51 days to 32.7 days (p = 0.0006).There was no significant reduction in days spent under the care of home treatment teams for individuals treated with either of these medicines.ConclusionTreatment with either paliperidone or aripiprazole long-acting injection was associated with a reduction in admissions and occupied bed days of a magnitude that delivered an overall cost-saving despite the high drug acquisition costs. It remains to be determined how these reductions compare with other second-generation long-acting injections and first-generation depot antipsychotics.

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High doses of second-generation long-acting antipsychotics in the treatment of patients with severe resistant schizophrenia. A six-year mirror-image study.

Psychiatry and Clinical Psychopharmacology ◽

10.5455/pcp.20201011042823 ◽

2020 ◽

Vol 30 (4) ◽

pp. 1

Author(s):

Juan Miranda ◽

Silvia ndez ◽

Francisco oz

Keyword(s):

Second Generation ◽

Mirror Image ◽

Image Study ◽

High Doses ◽

Long Acting

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First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness

PsycEXTRA Dataset ◽

10.1037/e553822013-001 ◽

2012 ◽

Keyword(s):

Comparative Effectiveness ◽

First Generation ◽

Second Generation ◽

Second Generation Antipsychotics

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The Sad Parable of the Second Generation Antipsychotics and the Clinical Practice of Psychopharmacology

PsycEXTRA Dataset ◽

10.1037/e625872012-003 ◽

2009 ◽

Author(s):

Morgan Sammons

Keyword(s):

Clinical Practice ◽

Second Generation ◽

Second Generation Antipsychotics

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Eine Stellungnahme zur Debatte über die „atypischen“ Antipsychotika

Die Psychiatrie ◽

10.1055/s-0038-1673446 ◽

2010 ◽

Vol 07 (01) ◽

pp. 11-17

Author(s):

A. Schmied ◽

W. Kissling ◽

J. M. Davis ◽

S. Leucht

Keyword(s):

Antipsychotic Drugs ◽

Second Generation ◽

Cost Utility ◽

First Episode ◽

Intervention Effectiveness ◽

Second Generation Antipsychotics ◽

First Episode Schizophrenia

ZusammenfassungSeit etwa zehn Jahren gibt es eine kontrovers geführte Debatte über die Antipsychotika der zweiten Generation („second generation antipsychotics“, SGA) in der Schizophreniebehandlung, die in der Publikation der sogenannten Effektivitätsstudien CATIE (Clinical Antipsychotic Trial of Intervention Effectiveness), CUtLASS (Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) und EUFEST (European First-Episode Schizophrenia Trial) gipfelte. In der vorliegenden Übersicht fassen wir die Ergebnisse dreier aktueller systematischer Reviews zusammen, in denen die Antipsychotika der zweiten Generation (SGAs) mit Placebo, mit konventionellen Antipsychotika oder direkt miteinander verglichen wurden. Wir stellen die Metaanalysen in den Kontext anderer systematischer Reviews und beleuchten sie vor dem Hintergrund von CATIE, CUtLASS und EUFEST. Unserer Meinung nach sind viele Ergebnisse konsistent, sie werden aber von verschiedenen Experten und Interessensvertretern unterschiedlich interpretiert. Die Daten zeigen, dass SGAs keine homogene Gruppe darstellen und dass diese eher verwirrende Einteilung aufgegeben werden sollte. Unserer Meinung nach stellen die SGAs nicht den Durchbruch dar, den die Industrie gerne sehen würde. Ihre unterschiedlichen Eigenschaften erlauben aber eine bessere Ausrichtung des Behandlungsplans an den Problemen des individuellen Patienten. Diese Medikamente haben die Behandlungspalette deutlich erweitert und die meisten Psychiater, ganz zu schweigen von den Patienten, würden wohl nur sehr ungerne auf diese Präparate verzichten wollen.

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