Citation

Crespo-Facorro B, Ortiz-Garcia De La Foz V, Mata I, Ayesa-Arriola R, Suarez-Pinilla P, Valdizan EM, Martinez-Garcia O, Pérez-Iglesias R. Psychopharmacology 2014; 231(2): 357-366.

Copyright

(Copyright © 2014, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00213-013-3241-3

PMID

unavailable

Abstract

Rationale: Discontinuation of antipsychotic treatment at early phases increases the risk of poor adherence to maintenance drug therapy. Differences among antipsychotics in terms of effectiveness may determine a good adherence to treatment.

OBJECTIVES: The aim of this study is to compare the clinical effectiveness of aripiprazole, ziprasidone and quetiapine in the treatment of first-episode schizophrenia spectrum disorders at 1 year.

METHOD: From October 2005 to January 2011 a prospective, randomized, open-label study was undertaken. Two hundred two first-episode drug-naïve patients were randomly assigned to aripiprazole (N = 78), ziprasidone (N = 62), or quetiapine (N = 62) and followed up for 1 year. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted in the analysis for clinical efficacy.

RESULTS: The overall dropout rate at 1 year was 13.37 %. The treatment discontinuation rate differed significantly between treatment groups (aripiprazole = 43.6 %, ziprasidone = 66.1 % and quetiapine = 82.3 %) (χ 2 = 22.545; p < 0.001). Insufficient efficacy in the group of quetiapine is the most important reason for differences in discontinuation rates between agents (χ 2 = 19.436; p < 0.001). The mean time to all-cause discontinuation was significantly different between groups (LogRank = 30.732 p < 0.001). The profile of extrapyramidal symptoms varies between treatments. Patients on ziprasidone were more likely to be prescribed antidepressants.

CONCLUSIONS: First episode patients treated with quetiapine have a higher risk of treatment discontinuation at midterm due to insufficient efficacy. Establishing differences between SGAs may help clinicians on prescribing decision for treatment of individuals presenting with first-episode non-affective psychosis. © 2013 Springer-Verlag Berlin Heidelberg.

Language: en

Keywords

Humans; adolescent; Adult; Female; Male; adult; human; suicide; female; male; Young Adult; Treatment Outcome; Schizophrenia; depression; schizophrenia; randomized controlled trial; scoring system; treatment outcome; Brief Psychiatric Rating Scale; Adverse effects; Psychotic Disorders; article; comparative study; major clinical study; controlled study; prescription; antidepressant agent; neuroleptic agent; rating scale; sedation; priority journal; quetiapine; somnolence; libido; constipation; sudden death; drug safety; psychometry; benzodiazepine derivative; follow up; patient compliance; drug efficacy; extrapyramidal symptom; weight gain; drug withdrawal; akathisia; cohort analysis; prospective study; hypnotic agent; Psychotherapeutic processes; erectile dysfunction; ziprasidone; asthenia; galactorrhea; parkinsonism; schizoaffective psychosis; Caucasian; sample size; Patient Dropouts; concentration loss; chronic fatigue syndrome; Antipsychotic Agents; aripiprazole; Dibenzothiazepines; mood stabilizer; unspecified side effect; muscarinic receptor blocking agent; amenorrhea; drug dose titration; treatment duration; open study; Clinical Global Impression scale; optimal drug dose; Piperazines; Quinolones; sleep time; ejaculation disorder; Thiazoles; absence of side effects; piperazine derivative; quinolone derivative; lassitude; Young Mania Rating Scale; dibenzothiazepine derivative; young adult; thiazole derivative; effect size; salivation; comparative effectiveness; Antipsychotic agents; patient dropouts; intention to treat analysis; Calgary Depression Scale; Barnes Akathisia Scale; Scale for the Assessment of Negative Symptoms; Scale for the Assessment of Positive Symptoms; Simpson Angus Rating Scale; Udvalg for Kliniske Undersogelser