Model-Guided Antipsychotic Dose Reduction in Schizophrenia
| Autor: | Masaru Mimura, Hiroyuki Uchida, Chisa Ozawa, Takefumi Suzuki, Robert R. Bies, Nikhil Pillai |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Olanzapine medicine.medical_treatment law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Humans Pharmacology (medical) Antipsychotic Aged Aged 80 and over Psychiatric Status Rating Scales Risperidone Dose-Response Relationship Drug Positive and Negative Syndrome Scale business.industry Middle Aged medicine.disease 030227 psychiatry Clinical trial Psychiatry and Mental health Dose–response relationship Schizophrenia Anesthesia Female business 030217 neurology & neurosurgery Antipsychotic Agents medicine.drug |
| Zdroj: | Journal of Clinical Psychopharmacology. 39:329-335 |
| ISSN: | 1533-712X 0271-0749 |
| DOI: | 10.1097/jcp.0000000000001046 |
| Popis: | Purpose/background Patients with schizophrenia as well as their psychiatrists are hesitant to reduce the antipsychotic dose in fear of relapse. To overcome such dilemmas, we developed models to individually calculate an oral dose that corresponds to a given target dopamine D2 receptor occupancy. Methods/procedures In this pilot, 52-week single-blind randomized controlled trial, 35 clinically stable patients with schizophrenia receiving either risperidone or olanzapine monotherapy were randomly assigned to dose reduction (n = 17) or dose maintenance group (n = 18). In the former group, baseline doses were reduced to the doses corresponding to 65% D2 occupancy (the lower end of therapeutic window) at trough that were calculated from randomly collected plasma concentrations using our models. Findings/results In the dose reduction group, doses of risperidone and olanzapine were decreased from 4.2 ± 1.9 to 1.4 ± 0.4 and 12.8 ± 3.9 to 6.7 ± 1.8 mg/d, whereas the doses in the dose maintenance group were 4.3 ± 1.9 and 15.8 ± 4.6 mg/d, respectively. Twelve subjects (70.5%) and 13 subjects (72.2%) in the dose reduction and dose maintenance groups completed the study (P = 0.604), whereas 3 subjects (18.8%) and none dropped out because of clinical worsening in the dose reduction and dose maintenance groups, respectively. There were not significant differences in score changes in Positive and Negative Syndrome Scale between the 2 groups but in Positive subscale scores in the Clinical Global Impression-Schizophrenia (0.4 ± 0.7 in the dose reduction group vs -0.1 ± 0.7 in the dose maintenance group, P = 0.029). Implications/conclusions Although our model-guided dose reduction strategy was found to be comparable with no-dose change in terms of dropout rates, safety issues have to be further examined. |
| Databáze: | OpenAIRE |
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