TY - JOUR
T1 - Switching strategies for antipsychotic monotherapy in schizophrenia
T2 - a multi-center cohort study of aripiprazole
AU - Obayashi, Yoshiaki
AU - Mitsui, Satoshi
AU - Sakamoto, Shinji
AU - Minao, Nozomu
AU - Yoshimura, Bunta
AU - Kono, Toshiki
AU - Yada, Yuji
AU - Okahisa, Yuko
AU - Takao, Soshi
AU - Kishi, Yoshiki
AU - Takeda, Toshihiko
AU - Takaki, Manabu
AU - Yamada, Norihito
N1 - Funding Information:
This work was supported in part by an award from the Dopamine Partial Agonist Society (Tokyo, Japan) (Manabu Takaki).
Funding Information:
N.Y. has received unrestricted research funding from Daiichi Sankyo, Eisai, Pfizer, Otsuka, Astellas, and Merck Sharp & Dohme, which was deposited into research accounts at Okayama University. N.Y. has received honoraria for his participation as a speaker at educational events from UCB Japan, Tsumura, Pfizer, Dainippon-Sumitomo, Daiichi-Sankyo, Merck Sharp & Dohme, Pfizer, Eisai, Meiji-Seika, and Mochida.
Funding Information:
S.S. has received unrestricted research funding from Eli Lilly, which was deposited into research accounts at Okayama University Hospital. S.S. has received honoraria for his participation as a speaker at an educational event sponsored by Otsuka.
Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Rationale: Changing antipsychotics of patients with chronic schizophrenia involves several risks. Switching to aripiprazole is especially difficult. We investigated switching methods and related factors for successful switching patients with chronic schizophrenia to aripiprazole. Objectives: This study was a multi-center historical cohort study and approved by the research ethics committee of Okayama University Hospital and Okayama Psychiatric Medical Center. We compared survival proportions of 178 chronic schizophrenia patients who continued aripiprazole monotherapy for 6 months after non-direct switching (add-on switching (n = 45), cross switching (n = 62)) or direct switching (n = 71). We adjusted possible confounders using a Cox proportional hazards model. Results: Of patients with chronic schizophrenia, 56.7% (101/178) were switched to aripiprazole monotherapy, and 55.0% (98/178) showed improvement in symptoms as demonstrated by the Clinical Global Impression Severity score. Kaplan-Meier survival curves showed that non-direct switching had a higher survival proportion than direct switching (log-rank test, p = 0.012). Even after adjusting for several variables using a Cox proportional hazards model, add-on switching had a significantly lower hazard at 6 months than direct switching (hazard ratio 0.42, 95% confidence interval 0.21–0.82, P = 0.01). In cases of switching to aripiprazole for psychiatric symptoms, non-direct switching had a lower hazard than direct switching (hazard ratio 0.41, 95% confidence interval 0.21–0.81, P = 0.01) but was not significant for adverse reaction. When aripiprazole was switched from olanzapine, add-on switch showed the lowest hazard ratio for continuation (hazard ratio 0.29, 95% confidence interval 0.07–1.11, P = 0.07). Conclusions: Flexibility in strategies when switching to aripiprazole may induce a better outcome for patients with chronic schizophrenia.
AB - Rationale: Changing antipsychotics of patients with chronic schizophrenia involves several risks. Switching to aripiprazole is especially difficult. We investigated switching methods and related factors for successful switching patients with chronic schizophrenia to aripiprazole. Objectives: This study was a multi-center historical cohort study and approved by the research ethics committee of Okayama University Hospital and Okayama Psychiatric Medical Center. We compared survival proportions of 178 chronic schizophrenia patients who continued aripiprazole monotherapy for 6 months after non-direct switching (add-on switching (n = 45), cross switching (n = 62)) or direct switching (n = 71). We adjusted possible confounders using a Cox proportional hazards model. Results: Of patients with chronic schizophrenia, 56.7% (101/178) were switched to aripiprazole monotherapy, and 55.0% (98/178) showed improvement in symptoms as demonstrated by the Clinical Global Impression Severity score. Kaplan-Meier survival curves showed that non-direct switching had a higher survival proportion than direct switching (log-rank test, p = 0.012). Even after adjusting for several variables using a Cox proportional hazards model, add-on switching had a significantly lower hazard at 6 months than direct switching (hazard ratio 0.42, 95% confidence interval 0.21–0.82, P = 0.01). In cases of switching to aripiprazole for psychiatric symptoms, non-direct switching had a lower hazard than direct switching (hazard ratio 0.41, 95% confidence interval 0.21–0.81, P = 0.01) but was not significant for adverse reaction. When aripiprazole was switched from olanzapine, add-on switch showed the lowest hazard ratio for continuation (hazard ratio 0.29, 95% confidence interval 0.07–1.11, P = 0.07). Conclusions: Flexibility in strategies when switching to aripiprazole may induce a better outcome for patients with chronic schizophrenia.
KW - Aripiprazole
KW - Chronic schizophrenia
KW - Cox proportional hazards model
KW - Monotherapy
KW - Switching
UR - http://www.scopus.com/inward/record.url?scp=85073941870&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073941870&partnerID=8YFLogxK
U2 - 10.1007/s00213-019-05352-7
DO - 10.1007/s00213-019-05352-7
M3 - Article
C2 - 31624859
AN - SCOPUS:85073941870
VL - 237
SP - 167
EP - 175
JO - Psychopharmacology
JF - Psychopharmacology
SN - 0033-3158
IS - 1
ER -