The Optimization of Treatment and Management of Schizophrenia in Europe (OPTiMiSE) Trial: Rationale for its Methodology and a Review of the Effectiveness of Switching Antipsychotics
| Autor: | Andreas Meyer-Lindenberg, Dan Rujescu, Shôn Lewis, Iris E. C. Sommer, René S. Kahn, Shitij Kapur, Phillip McGuire, Birte Glenthøj, Inge van Rossum, F. Markus Leweke, Stephan Heres, Stefan Leucht, Marion Leboyer, Celso Arango, W. Wolfgang Fleischhacker |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Olanzapine
medicine.medical_treatment Psychological intervention Review law.invention Benzodiazepines Randomized controlled trial Management of schizophrenia law nonresponse Outcome Assessment Health Care Multicenter Studies as Topic Non-U.S. Gov't first episode Clozapine Randomized Controlled Trials as Topic First episode Clinical Trials as Topic Research Support Non-U.S. Gov't Disease Management ddc Phase III as Topic Europe Psychiatry and Mental health Schizophrenia Amisulpride medicine.drug Antipsychotic Agents Adult medicine.medical_specialty olanzapine MEDLINE Influential Publications Research Support Outcome Assessment (Health Care) medicine Journal Article Humans Clinical Trials Psychiatry Antipsychotic algorithm business.industry Invited Themed Article medicine.disease Clinical trial amisulpride Clinical Trials Phase III as Topic Psychotic Disorders Sulpiride business |
| Zdroj: | Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid Consejería de Sanidad de la Comunidad de Madrid Schizophrenia Bulletin, 41(3), 549. Oxford University Press |
| ISSN: | 0586-7614 |
| Popis: | BACKGROUND: Most of the 13 542 trials contained in the Cochrane Schizophrenia Group's register just tested the general efficacy of pharmacological or psychosocial interventions. Studies on the subsequent treatment steps, which are essential to guide clinicians, are largely missing. This knowledge gap leaves important questions unanswered. For example, when a first antipsychotic failed, is switching to another drug effective? And when should we use clozapine? The aim of this article is to review the efficacy of switching antipsychotics in case of nonresponse. We also present the European Commission sponsored "Optimization of Treatment and Management of Schizophrenia in Europe" (OPTiMiSE) trial which aims to provide a treatment algorithm for patients with a first episode of schizophrenia. METHODS: We searched Pubmed (October 29, 2014) for randomized controlled trials (RCTs) that examined switching the drug in nonresponders to another antipsychotic. We described important methodological choices of the OPTiMiSE trial. RESULTS: We found 10 RCTs on switching antipsychotic drugs. No trial was conclusive and none was concerned with first-episode schizophrenia. In OPTiMiSE, 500 first episode patients are treated with amisulpride for 4 weeks, followed by a 6-week double-blind RCT comparing continuation of amisulpride with switching to olanzapine and ultimately a 12-week clozapine treatment in nonremitters. A subsequent 1-year RCT validates psychosocial interventions to enhance adherence. DISCUSSION: Current literature fails to provide basic guidance for the pharmacological treatment of schizophrenia. The OPTiMiSE trial is expected to provide a basis for clinical guidelines to treat patients with a first episode of schizophrenia. |
| Databáze: | OpenAIRE |
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