scholarly journals Switching Between Second-Generation Antipsychotics in Patients with Schizophrenia and Schizoaffective Disorder: 10-Year Cohort Study in Brazil

2021 ◽  
Vol 12 ◽  
Author(s):  
Izabela Fulone ◽  
Marcus Tolentino Silva ◽  
Luciane Cruz Lopes
Keyword(s):  
Cohort Study ◽  
Schizoaffective Disorder ◽  
Second Generation ◽  
Real Life ◽  
Assistance Program ◽  
Northeast Region ◽  
Factors Associated ◽  
Increased Risk ◽  
Second Generation Antipsychotics ◽  
Brazilian Northeast

Objective: Switching between second-generation antipsychotics (SGAs) is a common clinical practice in the treatment of schizophrenia and schizoaffective disorders due to differences in the drugs’ tolerability and safety profiles as well as the challenge of obtaining an ideal response. However, the factors associated with SGA switching remain uncertain and related real-world data are scarce. The main objective was to identify the factors associated with the switching of SGAs in patients with schizophrenia or schizoaffective disorder.Methods: We conducted a retrospective cohort study of outpatients with schizophrenia or schizoaffective disorder, who were aged ≥18 years and received a SGA (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a Brazilian pharmaceutical assistance program for at least 3 months. We identified SGA users from 2008 to 2017 by using a national administrative database (Ambulatory Information System-SIA/SUS). The factors associated with the switches were evaluated by Cox proportional hazards regression and adjusted for sex and age; the confidence interval was set at 95% (95% CI).Results: In total, 563,765 patients were included. Female sex, advanced age of ≥70 years, residence in the Brazilian northeast region, and the type of antipsychotic used were associated with an increased risk of switching (p < 0.001). The incidence of switching ranged from 37.6/100 person-years for clozapine users to 58.2/100 person-years for risperidone users. Compared to the adjusted hazard ratio, for clozapine users, the corresponding ratios for risperidone, ziprasidone, quetiapine and olanzapine were 1.59 (95% CI, 1.57–1.61), 1.41 (95% CI, 1.39–1.44), 1.25 (95% CI, 1.23–1.26) and 1.11 (95% CI, 1.10–1.12) respectively.Conclusion: The groups most susceptible to SGA switching in real-life setting were older individuals, women, and those living in the Brazilian northeast region. Risperidone was associated with the highest risk of switching and as expected, clozapine was associated with the lowest risk of switching than that associated with the other SGAs.

scholarly journals Clinical, Biochemical and Genetic Variables Associated With Metabolic Syndrome in Patients With Schizophrenia Spectrum Disorders Using Second-Generation Antipsychotics: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Marius H. Sneller ◽  
Nini de Boer ◽  
Sophie Everaars ◽  
Max Schuurmans ◽  
Sinan Guloksuz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Metabolic Syndrome ◽  
Second Generation ◽  
Genetic Factors ◽  
Schizophrenia Spectrum Disorders ◽  
Factors Associated ◽  
Schizophrenia Spectrum ◽  
Increased Risk ◽  
Second Generation Antipsychotics ◽  
Spectrum Disorders

Background: Individuals with severe mental illness experience increased morbidity and mortality compared to the general population. Adverse effects of antipsychotics, including weight gain, may contribute to the development of metabolic syndrome (MetS), which is associated with increased risks of all-cause and cardiovascular disease mortality. We aim to provide a comprehensive overview of clinical, biochemical and genetic factors associated with MetS among patients with schizophrenia spectrum disorders using second-generation antipsychotics (SGA).Methods: A literature search was performed in Pubmed and Embase to identify all cohort studies, cross-sectional studies and clinical trials investigating associations with MetS in patients with schizophrenia spectrum disorders using SGAs. We extracted and enumerated clinical, biochemical and genetic factors reported to be associated with MetS. We defined factors associated with MetS as factors being reported as associated with MetS in two or more studies.Results: 58 studies were included in this review (n = 12,123). In total, 62 factors were found to be associated with increased risk of MetS. Thirty one out of 58 studies investigated factors that were reported as associated with MetS in two or more studies. With regard to clinical factors, we found gender, higher age, concomitant use of mood stabilizers, higher baseline and current BMI, earlier SGA exposure, higher dose, longer duration of treatment, psychosis and tobacco smoking to be significantly associated with MetS. Furthermore, the biochemical factors hypo-adiponectinemia, elevated levels of C-reactive protein (CRP) and higher white blood cell (WBC) count were identified as factors associated with MetS. Among pharmacogenetic factors, the rs1414334 C-allele of the HTR2C-gene was associated with MetS in patients using SGA.Conclusion: In this systematic review investigating clinical, biochemical and genetic factors associated with MetS in patients using SGAs we found that higher age, higher baseline BMI, higher current BMI and male as well as female gender were positively associated with MetS across all antipsychotics. This study may set the stage for the application of clinical, biochemical and genetic factors to predict the risk of developing MetS in patients using SGAs. Future research is needed to determine which patients using SGAs are at risk to develop MetS in clinical practice.

Second generation antipsychotics in ‘real-life’ paediatric patients. Adverse drug reactions and clinical outcomes of drug switch

2016 ◽  
Vol 15 (sup2) ◽  
pp. 1-8 ◽  
Author(s):  
Concetta Rafaniello ◽  
Marco Pozzi ◽  
Simone Pisano ◽  
Carmen Ferrajolo ◽  
Silvana Bertella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Adverse Drug Reactions ◽  
Second Generation ◽  
Real Life ◽  
Drug Reactions ◽  
Paediatric Patients ◽  
Second Generation Antipsychotics

scholarly journals Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study

BMJ Open ◽  
2013 ◽  
Vol 3 (7) ◽  
pp. e003062 ◽  
Author(s):  
Alexander Sadowski ◽  
Michelle Todorow ◽  
Parvaneh Yazdani Brojeni ◽  
Gideon Koren ◽  
Irena Nulman
Keyword(s):  
Cohort Study ◽  
Psychotropic Drugs ◽  
Pregnancy Outcomes ◽  
Second Generation ◽  
Maternal Exposure ◽  
Second Generation Antipsychotics

RISK OF NEW ONSET TYPE II DM IN MDD PATIENTS RECEIVING SECOND-GENERATION ANTIPSYCHOTICS TREATMENT: A NATIONWIDE COHORT STUDY

2016 ◽  
Vol 33 (5) ◽  
pp. 435-443 ◽  
Author(s):  
Chun-Yuan Lin ◽  
Yu-Hsin Wu ◽  
Hong-Song Wang ◽  
Ping-Kun Chen ◽  
Yuan-Fu Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Second Generation ◽  
Type Ii ◽  
Onset Type ◽  
Second Generation Antipsychotics ◽  
New Onset

scholarly journals Comparative effectiveness of second-generation antipsychotics and haloperidol in acute schizophrenia

2006 ◽  
Vol 189 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Robert E. McCue ◽  
Rubina Waheed ◽  
Leonel Urcuyo ◽  
Geraldine Orendain ◽  
Michel D. Joseph ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Comparative Effectiveness ◽  
Second Generation ◽  
Rating Scale ◽  
Antipsychotic Agents ◽  
Schizophreniform Disorder ◽  
Open Label ◽  
Hospitalised Patients ◽  
Second Generation Antipsychotics ◽  
Psychiatric Rating Scale

BackgroundThere is little information on the comparative effectiveness of second-generation antipsychotic agents.AimsTo determine if any of five second-generation antipsychotics or haloperidol is more effective in treating acutely ill patients with schizophrenia, schizoaffective disorder or schizophreniform disorder.MethodA sample of 327 newly admitted patients were randomised to open-label treatment with aripiprazole, haloperidol, olanzapine, quetiapine, risperidone or ziprasidone for a minimum of 3 weeks. Measures of effectiveness were improvement in mental status so that the patient no longer required acute in-patient care, and changes in Brief Psychiatric Rating Scale (BPRS) scores.ResultsBy the first measure, haloperidol (89%), olanzapine (92%) and risperidone (88%) were significantly more effective than aripiprazole (64%), quetiapine (64%) and ziprasidone (64%). Changes in BPRS ratings were not significant among treatments.ConclusionsHaloperidol, olanzapine and risperidone are superior to aripiprazole, quetiapine and ziprasidone for the acute treatment of psychosis in hospitalised patients with schizophrenia, schizoaffective disorder or schizophreniform disorder.

scholarly journals Overcoming barriers to monitoring patients taking second-generation antipsychotics

2018 ◽  
Vol 8 (2) ◽  
pp. 49-55 ◽  
Author(s):  
Anita Peña ◽  
Beth DeJongh ◽  
Matthew Haas ◽  
Michelle Harms
Keyword(s):  
Metabolic Syndrome ◽  
Second Generation ◽  
Vital Signs ◽  
Baseline Monitoring ◽  
Metabolic Monitoring ◽  
Increased Risk ◽  
Second Generation Antipsychotics ◽  
Awareness Information ◽  
Before And After ◽  
Patient Referrals

Abstract Introduction: Patients taking second-generation antipsychotics (SGAs) are at increased risk of developing metabolic syndrome because of the side effect profiles of these medications. A medication use evaluation (MUE) was conducted and showed that baseline monitoring rates of metabolic parameters in patients taking SGAs are low. A pharmacist-run metabolic syndrome monitoring clinic (MSMC) is available to mental health (MH) outpatients; however, the clinic is underused by providers. The purpose of this project was to increase baseline metabolic syndrome monitoring rates in patients taking SGAs by implementing interventions to overcome barriers to monitoring and to accessing the MSMC. Methods: Appropriate tools to improve monitoring were obtained, and an electronic consult for the MSMC was created. A presentation and pamphlet were developed to improve awareness. Information about free patient transportation was obtained and distributed. Efficacy was assessed by evaluating patient referrals to the clinic before and after intervention, comparing baseline monitoring rates after implementation with the MUE data, and administering an anonymous survey to outpatient MH providers. Results: There was a 37.5% increase in overall referral rates to the MSMC after intervention, but only 51.5% of patients attended appointments as scheduled. Monitoring of vital signs increased, but monitoring of laboratory parameters decreased. A total of 60% (9 of 15) of providers completed a survey, of which one third indicated they still forget to refer patients to the MSMC. Discussion: Overall, baseline metabolic monitoring rates remained low despite implementing several interventions. Patient and provider outreach is crucial for initiating and maintaining a successful metabolic monitoring system for patients taking SGAs.

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