Two-Injection Start Regimen of Long-Acting Aripiprazole in 133 Patients With Schizophrenia.

PURPOSE/BACKGROUND: Based on a population-pharmacokinetic model, the European Medicines Agency has recently approved a simplified starting strategy of aripiprazole once a month (AOM), injectable and long-acting antipsychotic, with two 400 mg injections and a single oral 20 mg dose of aripiprazole, administered on the same day, instead of 1 injection and 14 daily administrations of concurrent oral aripiprazole. However, to our knowledge, no previous study has reported the safety and tolerability of this regimen in real-world patients. METHODS/PROCEDURES: We retrospectively reviewed medical records of 133 patients who received the newly approved 2-injection start regimen as part of their standard care in 10 Italian clinical centers. FINDINGS/RESULTS: Adverse effects were mild or moderate, with no clinically evident difference from the adverse effects observed in previous trials where AOM was started with a single injection followed by 14 days of orally administered aripiprazole. None of the patients who started AOM after the 2-injection start regimen experienced severe adverse effects or severe adverse effects. IMPLICATIONS/CONCLUSIONS: The coadministration of 2 injections of 400 mg aripiprazole and 20 mg oral aripiprazole was not associated with safety concerns beyond those reported after a single injection followed by 14 days of orally administered aripiprazole. Our results should be interpreted with caution, due to the limited sample size and to the retrospective design of the study.

[Full functional recovery in depression treatment. Clinical cases treated with vortioxetina]. / Full functional recovery nel trattamento della depressione. Casi clinici trattati con vortioxetina.

Depression is one of the most common diseases worldwide, with more than 350 million people affected. Although many patients initially show a good response to antidepressant therapy, they tend to suffer from residual symptoms that affect their social, cognitive, physical and psychological domains. Residual symptoms severely impact the patient's global functioning and quality of life and increase the risk of recurrence. In the last few years, pharmacological research has focused on drugs able to mitigate the severity of depressive symptoms and to control persistent cognitive and functional disabilities. A novel antidepressant, with a multimodal mechanism of action that combines the classical inhibition of serotonin transporter (SERT) with the modulation of serotonin receptor activity, is vortioxetine. Its efficacy in the treatment of depression and cognitive symptoms has been well established in numerous randomized clinical trials. Three cases of patients with depressive disorders are presented, in which vortioxetine treatment improved depressive symptoms, cognitive symptoms and overall patient functioning. These anecdotal experiences suggest that vortioxetine, in addition to controlling all symptoms of depression, including cognitive symptoms, provides functional benefits in patients with depressive disorders.

Switching long acting antipsychotic medications to aripiprazole long acting once-a-month: expert consensus by a panel of Italian and Spanish psychiatrists.

INTRODUCTION: Aripiprazole long acting once-monthly (AOM) is a long acting atypical antipsychotic with proven efficacy in schizophrenia and with a pharmacological and a side effect profile that is different from other antipsychotics. These and other characteristics make AOM a possible alternative in patients requiring a change in long acting antipsychotic treatment due to issues such as lack of efficacy or persistent side effects. Both clinical and pharmacological factors should be considered when switching antipsychotics, and specific guidelines for long acting antipsychotic switching that address all these factors are needed. AREAS COVERED: A panel of Italian and Spanish experts in psychiatry met to discuss the strategies for the switch to AOM in patients with schizophrenia. Real life clinical experiences were shared and the clinical strategies to improve the likelihood of success were discussed. EXPERT OPINION: Due to its specific pharmacological and tolerability profile, AOM represents a suitable alternative for patients with schizophrenia requiring a switch to a new LAI treatment because of lack of efficacy or persistent side effects from another LAI. Possible strategies for the switch to AOM are presented in this expert consensus paper in an attempt to provide guidance throughout the entire switching process.