Evaluation of oral antipsychotic supplementation of select second-generation long-acting injectable antipsychotics in an acute-care psychiatric setting

Abstract Introduction Long-acting injectable (LAI) antipsychotics were developed to increase medication adherence in patients with schizophrenia. The US Food and Drug Administration (FDA)-approved LAI dosing provides guidance regarding oral antipsychotic supplementation. Previous studies have concluded concomitant use of oral and LAI antipsychotics requires further investigation. The aim of this study was to examine oral antipsychotic supplementation among patients receiving select second-generation LAIs. Methods Patients were included if they were admitted to an inpatient psychiatric unit and received a second-generation LAI. The primary outcome was to determine the percentage of patients receiving oral antipsychotic supplementation prescribed in accordance with FDA recommendations. Secondary outcomes described oral supplementation prescribed in an inconsistent manner with FDA recommendations and identified patient-specific predictors associated with oral supplementation prescribed consistent with FDA recommendations. Results Of the 422 patients evaluated, 376 patients met inclusion criteria. Oral supplementation was prescribed in a manner consistent with FDA recommendations in 30% of patients. The following predictors were associated with oral supplementation prescribed in accordance with FDA recommendations: LAI initiation (odds ratio 1.868, 95% confidence interval 1.120-3.125) and the use of the once-monthly paliperidone LAI (odds ratio 20.278, 95% confidence interval 10.472-39.873). Discussion In the patient population evaluated, oral supplementation of LAI antipsychotics were prescribed in 30% of patients in a manner consistent with FDA recommendations. Of the patients who were prescribed oral antipsychotic supplementation inconsistent with FDA labeling, 223 patients were prescribed oral supplementation longer than the recommended duration and 8 patients received oral supplementation for a shorter duration than recommended.

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Abstract TP14: Predictors of Good Outcome after Endovascular Therapy for Acute Posterior Circulation Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp14 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mehdi Bouslama ◽

Ashutosh Jadhav ◽

Diogo C Haussen ◽

Amin Aghaebrahim ◽

Leticia C Rebello ◽

...

Keyword(s):

Confidence Interval ◽

Scale Score ◽

Endovascular Therapy ◽

Odds Ratio ◽

Univariate Analysis ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Patient Specific ◽

Posterior Circulation Stroke ◽

Good Outcome

Background and Purpose: Endovascular therapy (ET) is increasingly utilized in acute ischemic stroke treatment and is now considered the gold standard approach for select patient populations. Prior studies have demonstrated that eventual patient outcome depend on both patient specific factors as well as procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome after ET for acute posterior circulation stroke Methods: We reviewed our prospectively collected endovascular databases at two tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015. Baseline characteristics, procedural data and outcomes were evaluated. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 214 qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score (NIHSS), anesthesia modality (conscious sedation vs general anesthesia), procedural length and reperfusion status were significantly associated with outcomes in the univariate analysis Multivariate logistic regression indicated that only smoking (odds ratio, 2.49; 95% confidence interval 1.16-5.36; P=0.019), low NIHSS (odds ratio, 0.92; 95% confidence interval 0.88-0.96; P<0.001), and successful reperfusion (mTICI 2b-3) (odds ratio, 13.65; 95% confidence interval 1.71-108.76; P=0.014), were independent predictors of good outcomes. Conclusion: Our study suggests that baseline NIHSS, smoking and reperfusion status are independent predictors of good outcomes after ET for acute posterior circulation stroke.

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Oral Antipsychotic Update: A Brief Review of New and Investigational Agents for the Treatment of Schizophrenia

CNS Spectrums ◽

10.1017/s1092852912000727 ◽

2012 ◽

Vol 17 (s1) ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Leslie Citrome

Keyword(s):

Second Generation ◽

Dopamine D2 Receptor ◽

D2 Receptor ◽

Additional Information ◽

Potential Association ◽

Second Generation Antipsychotics ◽

The Us ◽

Glycine Transport ◽

Oral Antipsychotic ◽

Investigational Agents

This narrative review provides an overview of the three new oral second-generation antipsychotics that have become available in the US: iloperidone, asenapine and lurasidone. Although they are associated with less weight gain and fewer metabolic abnormalities than some of the older second-generation antipsychotics, iloperidone, asenapine and lurasidone have differences that make them unique from each other. Examples of these differences include dosing frequency, specific instructions on dosing with food, titration requirements, and potential association with sedation, extrapyramidal side effects, akathisia, and prolongation of the ECG QT interval. Additional information is provided regarding agents in late stage clinical development for the treatment of schizophrenia: cariprazine and brexpiprazole (both are dopamine D2 receptor partial agonists) and bitopertin (a glycine transport inhibitor that may have antipsychotic effects).

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Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

Patient Preference and Adherence ◽

10.2147/ppa.s127623 ◽

2017 ◽

Vol Volume 11 ◽

pp. 619-629 ◽

Cited By ~ 14

Author(s):

Dominic Pilon ◽

Kruti Joshi ◽

Neeta Tandon ◽

Marie-Hélène Lafeuille ◽

Rhiannon Kamstra ◽

...

Keyword(s):

Second Generation ◽

Treatment Patterns ◽

Oral Antipsychotic ◽

Long Acting

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Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867419837358 ◽

2019 ◽

Vol 53 (6) ◽

pp. 509-527 ◽

Cited By ~ 5

Author(s):

Andrew T Olagunju ◽

Scott R Clark ◽

Bernhard T Baune

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Atypical Antipsychotics ◽

Primary Outcome ◽

Mean Difference ◽

Controlled Trials ◽

Antipsychotic Medications ◽

Psychosocial Function ◽

Oral Antipsychotic ◽

Long Acting

Objective: Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. Methods: We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. Results: A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short- and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. Conclusion: Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.

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Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success?

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211033584 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110335

Author(s):

Hytham S. Salem ◽

Laura J. Huston ◽

Alexander Zajichek ◽

Eric C. McCarty ◽

Armando F. Vidal ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissue ◽

Confidence Interval ◽

Odds Ratio ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Activity Level ◽

Patient Specific ◽

Baseline Activity ◽

Anterior Cruciate

Background: When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis: The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results: A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs ( P < .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk ( P = .004). Conclusion: Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration: NCT00463099 (ClinicalTrials.gov identifier).

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Antipsychotic long-acting injections: Mind the gap

The British Journal of Psychiatry ◽

10.1192/bjp.195.52.s1 ◽

2009 ◽

Vol 195 (S52) ◽

pp. s1-s4 ◽

Cited By ~ 42

Author(s):

Maxine X. Patel ◽

Mark Taylor ◽

Anthony S. David

Keyword(s):

Treatment Adherence ◽

Patient Group ◽

Antipsychotic Medication ◽

Antipsychotic Drugs ◽

Second Generation ◽

Maintenance Medication ◽

Oral Antipsychotic ◽

Long Acting

SummaryLong-acting injections of antipsychotic medication (or depots) were developed specifically to promote treatment adherence and are a valuable option for maintenance medication in psychotic illnesses. Approximately 40–60% of patients with schizophrenia are partially or totally non-adherent to their antipsychotic regimen, but only 30% or less are prescribed a long-acting injection. The use of such injections has declined in recent years after the introduction of second-generation (atypical) oral antipsychotic drugs. Research shows that possible reasons for this decline include concerns that may be based on suboptimal knowledge, as well as an erroneous assumption that one's own patient group is more adherent than those of one's colleagues. Research on attitudes has also revealed that psychiatrists feel that long-acting injections have an ‘image’ problem. This editorial addresses the gaps in knowledge and behaviour associated with possible underutilisation of these formulations, highlighting the role of stigma and the need for more research.

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Differences in the Effectiveness of Long-Acting Injection and Orally Administered Antipsychotics in Reducing Rehospitalization among Patients with Schizophrenia Receiving Home Care Services

Journal of Clinical Medicine ◽

10.3390/jcm8060823 ◽

2019 ◽

Vol 8 (6) ◽

pp. 823

Author(s):

Hsiao-Fen Hsu ◽

Chia-Chan Kao ◽

Ti Lu ◽

Jeremy C. Ying ◽

Sheng-Yu Lee

Keyword(s):

Treatment Group ◽

Home Care ◽

Second Generation ◽

Home Care Services ◽

Rehospitalization Rate ◽

Treatment Groups ◽

Psychiatric Rehospitalization ◽

Care Services ◽

Long Acting

The current study explored the differences in the effectiveness of first and second generation long-acting injections and orally administered antipsychotics in reducing the rehospitalization rate among patients with schizophrenia receiving home care services in a medical center in Southern Taiwan. Longitudinal data between 1 January 2006, and 31 December 2015, were collected retrospectively. Patients were classified into three treatment groups: First generation antipsychotic (FGA) long-acting injection (LAI), second generation antipsychotic long-acting injection (SGA) (LAI), and oral antipsychotics. The primary outcomes were the rehospitalization rate and the follow-up time (duration of receiving home care services) until psychiatric rehospitalization. A total of 78 patients with schizophrenia were recruited. The average observation time was about 40 months. The oral treatment group tended to be older with a higher number of female patients and a lower level of education. The FGA treatment group tended to have a higher frequency and duration of hospitalization before receiving home care services. We found no significant differences in the follow-up time or psychiatric rehospitalization rate after receiving home care services among the three treatment groups. We propose that oral and LAI antipsychotics were equally effective when patients received home care services. Our results can serve as a reference for the choice of treatment for patients with schizophrenia in a home care program.

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Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-020-02776-5 ◽

2021 ◽

Author(s):

Qiao Qin ◽

Fangfang Fan ◽

Jia Jia ◽

Yan Zhang ◽

Bo Zheng

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Arterial Stiffness ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Augmentation Index ◽

Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

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Plasma acylcarnitines and risk of lower-extremity functional impairment in older adults: a nested case–control study

Scientific Reports ◽

10.1038/s41598-021-82912-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Francisco Félix Caballero ◽

Ellen A. Struijk ◽

Alberto Lana ◽

Antonio Buño ◽

Fernando Rodríguez-Artalejo ◽

...

Keyword(s):

Older Adults ◽

Confidence Interval ◽

Lower Extremity ◽

Functional Impairment ◽

Odds Ratio ◽

Case Control Study ◽

Case Control ◽

Community Dwelling ◽

Control Study ◽

Long Chain

AbstractElevated concentrations of acylcarnitines have been associated with higher risk of obesity, type 2 diabetes and cardiovascular disease. The aim of the present study was to assess the association between L-carnitine and acylcarnitine profiles, and 2-year risk of incident lower-extremity functional impairment (LEFI). This case–control study is nested in the Seniors-ENRICA cohort of community-dwelling older adults, which included 43 incident cases of LEFI and 86 age- and sex- matched controls. LEFI was assessed with the Short Physical Performance Battery. Plasma L-carnitine and 28 acylcarnitine species were measured. After adjusting for potential confounders, medium-chain acylcarnitines levels were associated with 2-year incidence of LEFI [odds ratio per 1-SD increase: 1.69; 95% confidence interval: 1.08, 2.64; p = 0.02]. Similar results were observed for long-chain acylcarnitines [odds ratio per 1-SD increase: 1.70; 95% confidence interval: 1.03, 2.80; p = 0.04]. Stratified analyses showed a stronger association between medium- and long-chain acylcarnitines and incidence of LEFI among those with body mass index and energy intake below the median value. In conclusion, higher plasma concentrations of medium- and long-chain acylcarnitines were associated with higher risk of LEFI. Given the role of these molecules on mitochondrial transport of fatty acids, our results suggest that bioenergetics dysbalance contributes to LEFI.

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