Abstract
BackgroundNon-adherence to antipsychotic medication in schizophrenic patients is common and associated with symptom relapse and poorer long-term outcomes. The risk factors for treatment non-adherence include dosing frequency and complexity. Besides, slower dose titration in an acute schizophrenic episode may lead to attenuated efficacy. Therefore, the convenient dosage regimen and rapid initiation scheme of quetiapine extended release (XR) were expected to provide better effectiveness and promote adherence in patients with schizophrenia. This study was implemented to assess the efficacy and safety of once-daily quetiapine XR in schizophrenic patients with switched from other antipsychotics which were suboptimal due to insufficient efficacy or tolerability.MethodsThis was a 12-week, open-label study conducted in the Chinese population in Taiwan.Patients who had a score of 4 (moderate) or greater on any of the 7 items of the Positive and Negative Syndrome Scale (PANSS) Positive Symptom Subscale and needed to switch from previous antipsychotics were recruited. Quetiapine XR was administered at 300 mg on day 1, 600 mg on day 2 and up to 800 mg after day 2. From day 8 until the end of the study, the dose of quetiapine XR was adjusted within 400-800 mg per day, depending on the clinical response and tolerance of the patients. The variable of the primary outcome was the change from baseline to Week 12 in PANSS total and subscale scores. Secondary outcome was the baseline-to-endpoint difference in the Clinical Global Impression-Severity (CGI-S) scores of the participants.ResultsSixty-one patients were recruited and 55.7% of them completed the study. The mean changes in the PANSS total score and CGI-S score showed significant improvement (−18.4, p < .001 and −1.0, p < .001, respectively). Four patients (6.7%) experienced adverse events including headache, exacerbation of psychosis and dysuria. The use of concomitant anticholinergics decreased from 15.0% to 8.3%.ConclusionsThe results of our investigation implicated that quetiapine XR was an effective and well tolerated alternative for Chinese schizophrenic patients with previous suboptimal treatment. Future large-scale studies are warranted to validate our results.Trial registrationClinicalTrials.gov ID NCT02142556. Registered 15 May 2014.
Highlights
Non-adherence to antipsychotic medication in schizophrenic patients is common and associated with symptom relapse and poorer long-term outcomes
Non-adherence to antipsychotic medication in schizophrenic patients has been considered to be a crucial contributor to symptom relapse and poorer longterm outcomes [5,6,7]. It is common for patients with schizophrenia to have low adherence to antipsychotics [8,9,10] and it had been reported that almost half of schizophrenic patients took less than 70% of the expected prescribed doses [11]
Any of the following was regarded as a criterion for exclusion from the study: (1) any DSM-IV-TR Axis I disorder other than schizophrenia, except comorbid obsessive-compulsive disorder, anxiety disorder, eating disorder or impulse control disorder if they had been stable and these had not been the primary focus of treatment over the previous 6 months; (2) an imminent risk of suicide or a danger to self or others; (3) pregnancy or lactation; (4) intolerance or lack of response to quetiapine IR; (5) use of cytochrome P450 3A4 inhibitors or inducers in the 14 days preceding enrollment; (6) administration of a depot antipsychotic injection within one dosing interval before recruitment; (7) unstable or inadequately treated medical illness as judged by the investigator
Summary
Non-adherence to antipsychotic medication in schizophrenic patients is common and associated with symptom relapse and poorer long-term outcomes. Non-adherence to antipsychotic medication in schizophrenic patients has been considered to be a crucial contributor to symptom relapse and poorer longterm outcomes [5,6,7]. It is common for patients with schizophrenia to have low adherence to antipsychotics [8,9,10] and it had been reported that almost half of schizophrenic patients took less than 70% of the expected prescribed doses [11]. The administration of the well tolerated antipsychotics which could be rapidly titrated to target dosage is critical for acute schizophrenic patients
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