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1.
Artigo em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1121615

RESUMO

Tecnologia: Aripiprazol, medicamento antipsicótico de segunda geração. Indicação: tratamento da esquizofrenia. Objetivos: Apresentar evidências de análise econômicas em saúde, no cenário do SUS e contextos internacionais, do tratamento com Aripiprazol para esquizofrenia, comparado a outros antipsicóticos de uso oral de primeira e segunda geração utilizados no SUS. Realizar uma análise de impacto orçamentário para o contexto do SUS em Goiás e estimar uma projeção de gastos diretos com aquisição de Aripiprazol pela Secretaria de Saúde de Goiás, em cenário de incorporação do Aripiprazol para tratamento de esquizofrenia, no período de 2021 a 2025. Materiais e Métodos: Levantamentos bibliográficos nas bases de dados PUBMED e Biblioteca Virtual em Saúde, no mês de junho de 2020. Realizada avaliação da qualidade metodológica das revisões sistemáticas e dos estudos econômicos com as ferramentas Assessing the Methodological Quality of Systematic Reviews (AMSTAR), e Quality of Health Economic Studies (QHES) checklist, respectivamente. Foi calculado o impacto orçamentário, seguindo diretrizes do Ministério da Saúde, e projeção de gastos para a Secretaria de Saúde de Goiás. Resultados: Foram selecionadas e incluídas 1 revisão sistemática e 1 estudo econômico brasileiro no estudo de revisão rápida de evidências. Conclusão: No contexto brasileiro, o Aripiprazol é custo-efetivo, quando comparado a Clorpromazina, Haloperidol, Quetiapina e Ziprasidona. Porém, é menos custo-efetivo que Risperidona e Olanzapina. Caso seja padronizado pela Secretaria de Saúde de Goiás, promoverá economia anual para o SUS de R$ 250.042,05 a R$ 407.418,41, em sua máxima difusão. A projeção de gastos diretos é estimada em R$1.582.115,24 a R$27.960.108,08


Technology: Aripiprazole, second generation antipsychotic medication. Indication: treatment of schizophrenia. Objectives: To show evidence of health economic analysis in the scenario of Brazilian Public Health System (BPHS) and international contexts, for schizophrenia treatment with Aripiprazole, compared to other oral antipsychotics used in BPHS. To make a budget impact analysis for the Goias Public Health System perspective and estimate direct expenditures for the acquisition of Aripiprazole by State Department of Health of Goias, in a scenario of technology incorporation of Aripiprazole for the treatment of schizophrenia, in the period from 2021 to 2025. Materials and Methods: Bibliographical searches were done in the PUBMED and Virtual Health Library databases, in 2020 June. An evaluation of the methodological quality of systematic reviews and economic studies was done using the tools AMSTAR (Assessing the Methodological Quality of Systematic Reviews), and QHES (Quality of Health Economic Studies) checklist, respectively. Calculation of budget impact, following guidelines of the Brazilian Health Ministry, and projection of expenditures for the State Department of Health of Goias. Results: 1 systematic review and 1 Brazilian economic study were selected and included in the study of rapid evidence review. Conclusion: In the Brazilian context, Aripiprazole is cost-effective when compared to Chlorpromazine, Haloperidol, Quetiapine and Ziprasidone. However, it is less cost-effective than Risperidone and Olanzapine. If it is standardized by State Department of Health of Goias, it will promote anual savings for BPHS from R$ 250,042.05 to R$ 407,418.41, in its maximum dissemination. The direct expenses are estimated at R$ 1,582,115.24 to R $ 27,960,108.08


Assuntos
Humanos , Esquizofrenia/tratamento farmacológico , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Análise de Impacto Orçamentário , Antipsicóticos/economia , Sistema Único de Saúde/economia , Aripiprazol/economia
2.
J Clin Psychiatry ; 81(5)2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32841554

RESUMO

OBJECTIVE: To describe the long-term safety, tolerability, and symptom trajectory with the long-acting injectable antipsychotic aripiprazole lauroxil (AL) in patients with DSM-5-diagnosed schizophrenia followed for up to 180 weeks (3.5 years). METHODS: Long-term safety of 2 fixed doses of AL (441 or 882 mg every 4 weeks) was assessed during up to 180 weeks (3.5 years) of continuous AL exposure using data from 2 sequential long-term safety studies. Safety metrics included adverse events (AEs), AEs leading to study discontinuations, physical examinations, laboratory parameters, and extrapyramidal symptom (EPS) rating scales. Symptom trajectory was assessed in post hoc analyses using Positive and Negative Syndrome Scale total (PANSST) and Clinical Global Impressions-Severity of Illness scale (CGI-S) scores. RESULTS: A total of 478 patients entered the 52-week study and were included in the safety analysis. After the first 52 weeks, safety assessments revealed no new safety concerns and were consistent with the known safety profile of aripiprazole. AEs were reported by 57.5% of patients (441 mg, 52.7%; 882 mg, 59.0%). EPS-related AEs occurred in 12.8% of patients (441 mg, 9.1%; 882 mg, 13.9%). In the post hoc analysis (n = 432), least-squares mean (SE) PANSST scores improved significantly from weeks 12 to 124 with AL 441 mg (-5.5 [0.9]) and 882 mg (-5.0 [0.5]; both P < .0001). CGI-S scores followed a similar pattern of improvement. CONCLUSIONS: The AL safety profile over 180 weeks (3.5 years) of follow-up was consistent with prior 52-week results. Continued therapeutic efficacy, based on PANSST and CGI-S scores, was observed throughout the post hoc analysis period. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01626456; ClinicalTrials.gov identifier: NCT01895452.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Aripiprazol/administração & dosagem , Aripiprazol/efeitos adversos , Preparações de Ação Retardada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
J Clin Psychiatry ; 81(4)2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32603560

RESUMO

OBJECTIVE: To determine whether concurrent posttraumatic stress disorder (PTSD) should affect whether to augment or switch medications when major depressive disorder (MDD) has not responded to a prior antidepressant trial. METHODS: Patients at 35 Veterans Health Administration medical centers from December 2012 to May 2015 with nonpsychotic MDD (N = 1,522) and a suboptimal response to adequate antidepressant treatment were randomly assigned to 3 "next step" treatments: switching to bupropion, augmenting the current antidepressant with bupropion, and augmenting with the antipsychotic aripiprazole. Blinded ratings with the 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C16) determined remission and response by 12 weeks and relapse after remission. Survival analyses compared treatment effects in patients with concurrent PTSD diagnosed with the Mini-International Neuropsychiatric Interview (n = 717, 47.1%) and those without PTSD (n = 805, 52.9%). RESULTS: Patients diagnosed with PTSD showed more severe depressive symptoms at baseline and were less likely to achieve either remission or response by 12 weeks. Augmentation with aripiprazole was associated with greater likelihood of achieving response (68.4%) than switching to bupropion (57.7%) in patients with PTSD (relative risk [RR] = 1.26; 95% CI, 1.01-1.59) as well as in patients without PTSD (RR = 1.29; 95% CI, 1.05-1.97) (78.9% response with aripiprazole augmentation vs 66.9% with switching to bupropion). Treatment comparisons with the group receiving augmentation with bupropion were not significant. There was no significant interaction between treatment group and PTSD on remission (P = .70), response (P = .98), or relapse (P = .15). CONCLUSIONS: Although PTSD was associated with poorer overall outcomes, the presence of concurrent PTSD among Veterans in this trial did not affect the comparative effectiveness of medications on response, remission, or relapse after initial remission. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01421342.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Adolescente , Adulto , Antidepressivos/uso terapêutico , Aripiprazol/uso terapêutico , Bupropiona/uso terapêutico , Transtorno Depressivo Maior/complicações , Resistência a Medicamentos/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Transtornos de Estresse Pós-Traumáticos/complicações , Adulto Jovem
4.
J Clin Psychiatry ; 81(4)2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32558403

RESUMO

People with bipolar I disorder experience an illness course marked by potentially disastrous manic episodes, disabling depressive episodes, and functional impairment. A frequent obstacle to wellness in these individuals is nonadherence to treatment. Long-acting injectable (LAI) antipsychotics have the potential to address nonadherence and thereby increase patients' chances at sustained recovery and normal psychosocial functioning. LAI formulations of 2 second-generation antipsychotics-aripiprazole monohydrate and risperidone-have received approval from the US Food and Drug Administration as monotherapy or adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder in adult patients. In a recent roundtable meeting, a panel of 4 experts discussed the use of these medications in bipolar I disorder. This Academic Highlights summarizes their discussion, which included the impact of functional impairment, the potential benefits of employing an LAI antipsychotic at earlier stages of bipolar illness, and the characteristics of patients who may be good candidates for treatment with an LAI antipsychotic.


Assuntos
Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Seleção de Pacientes , Risperidona/uso terapêutico , Aripiprazol/administração & dosagem , Análise Custo-Benefício , Preparações de Ação Retardada/uso terapêutico , Humanos , Injeções , Injeções Intramusculares , Adesão à Medicação , Guias de Prática Clínica como Assunto , Risperidona/administração & dosagem
5.
J Clin Psychiatry ; 81(4)2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32558407

RESUMO

OBJECTIVE: Differential predictors of response to alternative treatment options are needed to improve the outcomes in major depressive disorder. The symptom dimension comprising loss of interest and reduced activity has been reported as a predictor of poor outcome of treatment with antidepressants. We hypothesized that augmentation with partial dopamine agonist aripiprazole will be effective for individuals with pronounced interest-activity symptoms. METHODS: We tested the hypothesis in the 2-phase Canadian Biomarker Integration Network in Depression trial 1 (CAN-BIND-1). All participants had a primary diagnosis of major depressive disorder confirmed with the Mini-International Neuropsychiatric Interview. In phase 1, 188 individuals received escitalopram monotherapy 10-20 mg daily for 8 weeks. In phase 2, nonresponders received augmentation with aripiprazole 2-10 mg daily while responders continued escitalopram monotherapy for another 8 weeks. Outcomes were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) every 2 weeks. Effects of baseline interest-activity symptoms on outcomes were tested in repeated-measures mixed-effects models. RESULTS: Higher baseline interest-activity score (indicative of more severe loss of interest and reduction in activity) predicted worse outcome of escitalopram monotherapy in phase 1 (b = 1.75; 95% CI, 0.45 to 3.05; P = .009), but the association disappeared with the augmentation option in phase 2 (b = -0.19; 95% CI, -1.30 to 0.92; P = .739). A significant interaction between the baseline interest-activity score and aripiprazole reflected the opposite direction of the relationship between baseline interest-activity score and degree of improvement with escitalopram monotherapy versus aripiprazole augmentation (b = -1.60; 95% CI, -2.35 to -0.84; P < .001). CONCLUSIONS: Individuals with prominent loss of interest and reduction in activity benefit less from escitalopram monotherapy and more from aripiprazole augmentation. Future trials may test the benefits of early prodopaminergic augmentation guided by interest-activity symptoms. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01655706.


Assuntos
Aripiprazol/uso terapêutico , Citalopram/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Letargia/tratamento farmacológico , Adolescente , Adulto , Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Depressivo Maior/complicações , Agonistas de Dopamina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Letargia/complicações , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
J Clin Psychiatry ; 81(3)2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32433835

RESUMO

OBJECTIVE: Evaluate efficacy and safety of a 2-month formulation of aripiprazole lauroxil (AL) with 1-day initiation during hospitalization for acute exacerbation of schizophrenia followed by transition to outpatient care. METHODS: The phase 3b double-blind Aripiprazole Lauroxil and Paliperidone palmitate: INitiation Effectiveness (ALPINE) study was conducted from November 2017 to March 2019. Adults with acute schizophrenia according to DSM-5 criteria were randomized (1:1) to AL (AL NanoCrystal Dispersion + oral aripiprazole 30 mg, day 1; AL 1,064 mg, day 8 and every 8 weeks [q8wk]) or paliperidone palmitate (PP 234 mg, day 1; PP 156 mg, day 8 and then q4wk) for 25 weeks. Patients remained hospitalized ≥ 2 weeks after randomization per protocol. Primary endpoint was within-group change in Positive and Negative Syndrome Scale total score (PANSST) from baseline to week 4. Secondary analyses included within- and between-group changes from baseline at various time points. Adverse events (AEs) and laboratory data were monitored. RESULTS: A total of 200 patients were randomized (AL, n = 99; PP, n = 101); 56.6% and 42.6%, respectively, completed the study. For AL, the mean baseline PANSST was 94.1; scores were significantly reduced from baseline at week 4 (-17.4; P < .001) and were also reduced at weeks 9 (-19.8) and 25 (-23.3). With PP, PANSST also improved significantly from baseline (94.6) at week 4 (-20.1; P < .001) and also improved at weeks 9 (-22.5) and 25 (-21.7). The 3 most common AEs over 25 weeks in the AL group were injection site pain (17.2%), increased weight (9.1%), and akathisia (9.1%). The same AEs were the most common in the PP group (injection site pain [24.8%], increased weight [16.8%], and akathisia [10.9%]). CONCLUSIONS: AL and PP were efficacious and well-tolerated for initiating treatment of schizophrenia in the hospital and continuing outpatient treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03345979.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Assistência Ambulatorial , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Aripiprazol/administração & dosagem , Aripiprazol/efeitos adversos , Preparações de Ação Retardada , Método Duplo-Cego , Hospitalização , Humanos , Injeções Intramusculares , Pessoa de Meia-Idade , Palmitato de Paliperidona/administração & dosagem , Palmitato de Paliperidona/efeitos adversos , Palmitato de Paliperidona/uso terapêutico , Alta do Paciente , Adulto Jovem
7.
Can J Physiol Pharmacol ; 98(4): 236-242, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228235

RESUMO

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder, of unknown etiology, that affects 2.5% of the population. An appropriate therapeutic response to conventional treatment is seen. Some studies use augmentative treatment by antipsychotics, glutamatergic, lithium, buspirone, and others agents to improve the therapeutic response. In this study, we aimed to evaluate the efficacy and tolerability of aripiprazole and quetiapine as augmentative treatments in patients with selective serotonin reuptake inhibitor (SSRI) refractory OCD. The OCD patients were initially treated for 12 weeks with a SSRI. If after 12 weeks their Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score was more than 16, they were randomly assigned to either the aripiprazole or the quetiapine augmentation group for an additional 12 weeks. There were no significant differences in age, sex, education, marital status, or score of Y-BOCS and Clinical Global Impression-Severity Scale (CGI-S) between groups (p > 0.05) at the outset of the study. Significant differences were noted after 1 month when compared with results at 2, 3, and 4 months in both groups (p < 0.001). Both quetiapine and aripiprazole may be effective and well-tolerated augmentative agents in the treatment of SSRI-refractory OCD. Because of positive results, aripiprazole may be considered more effective and may have a more rapid onset in terms of therapeutic response.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Fumarato de Quetiapina/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Serotonina/metabolismo , Adulto , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/metabolismo , Método Simples-Cego
8.
J Clin Psychiatry ; 81(3)2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32237292

RESUMO

OBJECTIVE: To compare longitudinal metabolic effects of 7 antipsychotics, including body mass index (BMI), waist circumference (WC), blood pressure (BP), glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C); to investigate risk factors for metabolic syndrome (MetS); and to make recommendations on frequency and timing of monitoring metabolic measurements. METHODS: This randomized, open-label, pharmacologic trial was conducted among patients with schizophrenia (DSM-IV) in 32 hospitals across China. Patients were randomly assigned to 7 groups and assessed at baseline, 2, 4, and 6 weeks. Linear mixed-effect models were used to assess changes of metabolic measures over time. Multivariable logistic regression analysis was performed to investigate the risk factors for MetS. RESULTS: In total, 2,550 (718 drug-naïve) of 2,774 patients finished the study between July 6, 2010, and November 30, 2011. We found significant (P < .05) changes for BMI, WC, TG, and LDL-C, with TG and LDL-C reaching a plateau. Interactions between baseline metabolic condition and changes over time were observed for BMI (χ² = 43.11, P < .001), WC (χ² = 36.34, P < .001), systolic BP (χ² = 11.92, P = .002), glucose (χ² = 6.09, P = .01), and TG (χ² = 6.01, P = .01). Antipsychotics generally had greater adverse effects on patients who were initially screened as metabolically normal. After controlling for other associated factors, we found that antipsychotics resulted in differing risk for incident MetS, with a similar pattern to findings in other populations: olanzapine (odds ratio [OR] = 3.36, P < .001) > quetiapine (OR = 3.29, P < .001) > perphenazine (OR = 2.73, P = .007) > risperidone (OR = 2.21, P = .02) > aripiprazole (OR = 1.74, P = .15) ≈ haloperidol (OR = 1.75, P = .22) ≈ ziprasidone (OR = 1, reference). CONCLUSIONS: Metabolic traits should be monitored frequently in early stages of antipsychotic treatment due to rapid and substantial changes. Clinicians should not assume low risk for patients with normal metabolic parameters at baseline. TRIAL REGISTRATION: Chinese Clinical Trial Registry identifier: ChiCTR-TRC-10000934.


Assuntos
Antipsicóticos/efeitos adversos , Síndrome Metabólica/induzido quimicamente , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Aripiprazol/efeitos adversos , Aripiprazol/uso terapêutico , Glicemia/efeitos dos fármacos , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Olanzapina/efeitos adversos , Olanzapina/uso terapêutico , Piperazinas/efeitos adversos , Piperazinas/uso terapêutico , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Fatores de Risco , Risperidona/efeitos adversos , Risperidona/uso terapêutico , Esquizofrenia/metabolismo , Tiazóis/efeitos adversos , Tiazóis/uso terapêutico , Triglicerídeos/sangue
9.
Psychiatry Res ; 287: 112905, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32163785

RESUMO

To conduct an updated overview of systematic reviews (SRs) summarizing the efficacy and safety of various strategies used to treat tic disorders (TDs) in children. We searched the Cochrane Library, PubMed, EMBASE, and relevant reference lists for articles published between the search deadline from our last overview and April 2019 and included 16 SRs. The results presented that antipsychotics, a2-adrenergic receptor agonists, and HRT/CBIT still appeared to be the most robust evidence-based options for the treatment of TDs. Compared with our last overview, more robust evidence showed that aripiprazole and acupuncture was effective treatment in treating children TDs, and DBS for medication-refractory and severely affected patients. In addition, physical activity or exercise may be promising treatments, and the clonidine adhesive patch is an effective, safe, and convenient treatment option for TDs. Moreover, methylphenidate, guanfacine, and desipramine appeared to reduce ADHD symptoms in children with tics. However, no research studies have examined HRT/CBIT alone compared with HRT/CBIT in combination with medication. More high-quality clinical trials comparing different interventions for TDs including economic evaluations should be encouraged.


Assuntos
Exercício Físico/fisiologia , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Transtornos de Tique/diagnóstico , Transtornos de Tique/terapia , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Criança , Análise Custo-Benefício , Exercício Físico/psicologia , Guanfacina/uso terapêutico , Humanos , Metilfenidato/uso terapêutico , Transtornos de Tique/psicologia , Resultado do Tratamento
10.
Psychopharmacology (Berl) ; 237(5): 1459-1470, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32002559

RESUMO

RATIONALE: What is the difference between aripiprazole and brexpiprazole? OBJECTIVES: This systematic review, network meta-analysis of randomized trials evaluated the efficacy and safety/tolerability of aripiprazole and brexpiprazole for treating acute schizophrenia. METHODS: We searched Scopus, MEDLINE, and Cochrane Library from inception until May 22, 2019. The response rate was set as the primary outcome. Other outcomes were discontinuation rate and incidence of individual adverse events. The risk ratio (RR) and 95% credible interval (95%CrI) were calculated. RESULTS: Fourteen studies were identified (n = 3925). Response rates of both aripiprazole and brexpiprazole were superior to that of the placebo (RR [95%CrI]: aripiprazole = 0.84 [0.78, 0.92], brexpiprazole = 0.84 [0.77, 0.92]). Aripiprazole and brexpiprazole were associated with a lower incidence of all-cause discontinuation (0.80 [0.71, 0.89], 0.83 [0.72, 0.95]), adverse events (0.67 [0.47, 0.97], 0.64 [0.46, 0.94]), and inefficacy (0.56 [0.40, 0.77], 0.68 [0.48, 0.99]) compared with the placebo. Although brexpiprazole was associated with a lower incidence of schizophrenia as an adverse event compared with the placebo (0.57 [0.37, 0.85]), aripiprazole and brexpiprazole were associated with a higher incidence of weight gain compared with the placebo (2.12 [1.28, 3.68], 2.14 [1.35, 3.42]). No significant differences were found in other individual adverse events, such as somnolence, akathisia, extrapyramidal symptoms, and dizziness between aripiprazole or brexpiprazole and placebo. Any outcome between aripiprazole and brexpiprazole were not different. CONCLUSIONS: Differences in short-term efficacy and safety for acute schizophrenia were not apparent between aripiprazole and brexpiprazole. Future studies are warranted to evaluate whether there are differences in the long-term outcome between treatments.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Quinolonas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Tiofenos/uso terapêutico , Doença Aguda , Acatisia Induzida por Medicamentos/diagnóstico , Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Humanos , Metanálise em Rede , Quinolonas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Esquizofrenia/diagnóstico , Tiofenos/efeitos adversos , Ganho de Peso/efeitos dos fármacos , Ganho de Peso/fisiologia
13.
Clin Ther ; 42(1): 77-93, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31928831

RESUMO

PURPOSE: Brexpiprazole is an oral atypical antipsychotic (OAA) for the treatment of schizophrenia (SCZ). This study compared all-cause and psychiatric inpatient hospitalization and medical costs in adult patients with SCZ newly treated with brexpiprazole versus other US Food and Drug Administration-approved OAAs in a real-world setting. METHODS: This retrospective cohort study analyzed data from: (1) the IBM MarketScan Commercial and Medicare Supplemental databases, and the MarketScan Multi-State Medicaid database; and (2) the de-identified Optum Clinformatics Datamart. Adult patients were identified if they had SCZ and initiated either brexpiprazole or another OAA during the study identification period (July 1, 2015, to September 30, 2016, for MarketScan Commercial and Medicare Supplemental and for Optum; July 1, 2015, to June 30, 2016, for MarketScan Multi-State Medicaid) and had ≥12 months of continuous enrollment before (baseline) and after (follow-up) the first treatment date. Linear regression analyses were performed to test associations between treatment groups (brexpiprazole vs another OAA) and costs (total and medical); negative binomial regression models were used to estimate number of hospitalizations per year, adjusting for baseline characteristics and medication adherence to index treatment during the 12-month follow-up. FINDINGS: The final study sample consisted of 6254 patients with SCZ: 176 initiated brexpiprazole; 391, ziprasidone; 453, paliperidone; 523, lurasidone; 786, aripiprazole; 1234, quetiapine; 1264, olanzapine; and 1427, risperidone. Controlling for baseline characteristics and medication adherence, the adjusted number of hospitalizations (both all-cause and psychiatric), all-cause total costs, and all-cause medical costs did not differ across groups. Brexpiprazole users had the lowest mean psychiatric costs among all OAA users ($12,013; 95% bootstrap CI, 7488-16,538). Compared with brexpiprazole users, paliperidone (incidence rate ratio [95% CI], 1.52 [1.05-2.19]; P = 0.027) and quetiapine (incidence rate ratio [95% CI], 1.47 [1.04-2.07]; P = 0.029) users had more psychiatric hospitalizations per year. Paliperidone had higher psychiatric costs than brexpiprazole (total, $32,066 [95% bootstrap CI, 28,779-35,353] vs $23,851 [18,907-28,795]; medical, $19,343 [16,294-22,392] vs $12,013 [7488-16,538]). Psychiatric medical costs were also $6744 higher in olanzapine users (95% bootstrap CI, 1694-11,795; P = 0.009) than in brexpiprazole users. IMPLICATIONS: Patients with SCZ treated with brexpiprazole had fewer psychiatric hospitalizations and lower psychiatric costs than those treated with paliperidone. Differences in the number of all-cause hospitalizations and medical costs among treatments were not statistically significant. Although treatment decisions are driven by a number of factors (eg, clinical circumstances and drug costs), choice of OAA may affect health care costs.


Assuntos
Antipsicóticos/economia , Hospitalização/economia , Quinolonas/economia , Esquizofrenia/economia , Tiofenos/economia , Administração Oral , Adulto , Antipsicóticos/uso terapêutico , Aripiprazol/economia , Aripiprazol/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Humanos , Cloridrato de Lurasidona/economia , Cloridrato de Lurasidona/uso terapêutico , Masculino , Medicaid/economia , Medicare/economia , Pessoa de Meia-Idade , Olanzapina/economia , Olanzapina/uso terapêutico , Palmitato de Paliperidona/economia , Palmitato de Paliperidona/uso terapêutico , Piperazinas/economia , Piperazinas/uso terapêutico , Fumarato de Quetiapina/economia , Fumarato de Quetiapina/uso terapêutico , Quinolonas/uso terapêutico , Risperidona/economia , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Tiazóis/economia , Tiazóis/uso terapêutico , Tiofenos/uso terapêutico , Estados Unidos
14.
Artigo em Inglês | MEDLINE | ID: mdl-31999895

RESUMO

Objective: To demonstrate how effectively aripiprazole can be utilized to manage antipsychotic-induced hyperprolactinemia. Methods: The files of 3 female patients with a history of psychotic illness and hyperprolactinemia who were treated at a state hospital between February 2018 and May 2019 were retrospectively analyzed. All were found to have elevated prolactin levels and underwent treatment with aripiprazole in addition to their concomitant medications. Results: In general, the addition of aripiprazole to the treatment regimen of each of the patients corresponded to a decline in their serum prolactin levels. Conclusions: Hyperprolactinemia is frequently observed in patients treated with antipsychotic medications. Low-dose treatment with aripiprazole may offer a relatively rapid relief from sustained hyperprolactinemia and associated adverse effects even after a long-acting injectable is discontinued.


Assuntos
Antipsicóticos/efeitos adversos , Aripiprazol/uso terapêutico , Hiperprolactinemia/induzido quimicamente , Adulto , Feminino , Humanos , Hiperprolactinemia/tratamento farmacológico , Pessoa de Meia-Idade , Prolactina/sangue , Transtornos Psicóticos/tratamento farmacológico , Estudos Retrospectivos , Esquizofrenia/tratamento farmacológico
15.
Eur J Clin Pharmacol ; 76(4): 491-499, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31900543

RESUMO

PURPOSE: Delirium is reported in over 50% of critically ill ICU patients, and is associated with increased mortality and long-term cognitive consequences. Prevention and early management of delirium are essential components of ICU care. However, pharmacological interventions have not been effective in delirium prevention. This study investigated the effect of aripiprazole in the prevention of delirium in a neurosurgical intensive care unit. METHODS: In this prospective, randomized placebo-controlled small clinical trial, 53 patients, 18 to 80 years old, were randomized to receive enteric aripiprazole (15 mg) or placebo for up to 7 days. Delirium, detected by the Confusion Assessment Method-ICU, ICU events, laboratory studies, aripiprazole safety, time to delirium onset, delirium-free days, delirium prevalence during follow-up and ICU length of stay were recorded. RESULTS: Forty patients with similar baseline characteristics, including age, sex, neurosurgery types and APACHE II scores, completed the study. Delirium incidence and the mean days to its onset were 20% vs. 55% (p = 0.022) and 2.17 ± 0.41 vs. 2.09 ± 0.30 (p = 0.076) in the aripiprazole and placebo groups, respectively. The mean number of delirium-free days were: 5.6 (95%CI, 4.6-6.5) and 4.3 (95%CI, 3.2-5.4), in aripiprazole and placebo groups, respectively (p = 0.111). The prevalence of delirium during the follow-up was significantly lower in the aripiprazole group (p = 0.018). Serious aripiprazole adverse reactions were not observed. CONCLUSIONS: Aripiprazole can reduce the incidence of delirium in the neurosurgical ICU. Studies with larger sample size in diverse ICU settings and longer follow-up are needed to confirm our findings.


Assuntos
Aripiprazol/uso terapêutico , Delírio/prevenção & controle , Procedimentos Neurocirúrgicos , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , APACHE , Adulto , Aripiprazol/administração & dosagem , Aripiprazol/efeitos adversos , Estado Terminal , Método Duplo-Cego , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Agonistas do Receptor 5-HT1 de Serotonina/administração & dosagem , Agonistas do Receptor 5-HT1 de Serotonina/efeitos adversos , Resultado do Tratamento
16.
Psychiatr Prax ; 47(1): 43-45, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31284315

RESUMO

Hypersexual behavior can be assumed as a rare side effect of treatment with aripiprazole and is possibly due to partial agonism on dopamine receptors or partial agonism on 5-HT1A receptors and 5 HT2A antagonism.


Assuntos
Antipsicóticos , Aripiprazol , Comportamento Sexual , Disfunções Sexuais Psicogênicas/induzido quimicamente , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Aripiprazol/efeitos adversos , Aripiprazol/uso terapêutico , Alemanha , Humanos , Receptor 5-HT1A de Serotonina , Receptor 5-HT2A de Serotonina , Antagonistas do Receptor 5-HT2 de Serotonina , Disfunções Sexuais Psicogênicas/psicologia
18.
J Clin Psychopharmacol ; 40(1): 14-17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31834097

RESUMO

BACKGROUND: Hyperprolactinemia is a troublesome adverse effect of antipsychotics. Aripiprazole (ARP), which is one of second-generation antipsychotics, has been reported to lower serum prolactin (PRL) levels. However, few studies have compared the effect of ARP on plasma PRL levels between monopharmacy and polypharmacy with antipsychotics. METHODS: We conducted a large-scale investigation of the physical risk for inpatients with schizophrenia using a questionnaire covering demographic data, the number, dose and type of antipsychotics, and serum PRL levels. RESULTS: Sufficient data to conduct an assessment of the effect on PRL levels between antipsychotic monopharmacy and polypharmacy were obtained from 316 of the inpatients. Serum PRL levels in ARP combination group were lower than non-ARP combination group, regardless of antipsychotic monopharmacy or polypharmacy. CONCLUSIONS: The present study suggests that ARP lowers serum PRL levels regardless of monopharamacy or polypharmacy with antipsychotics.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Prolactina/sangue , Esquizofrenia/tratamento farmacológico , Adulto , Idoso , Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Estudos Transversais , Regulação para Baixo , Quimioterapia Combinada , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Polimedicação , Esquizofrenia/sangue , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Resultado do Tratamento
19.
Psychopharmacology (Berl) ; 237(1): 167-175, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31624859

RESUMO

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.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
20.
J Clin Psychiatry ; 80(6)2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31846575

RESUMO

OBJECTIVE: To determine the likelihood of antidepressant response in older adults with major depression as a function of their prior antidepressant trials. METHODS: 500 older adults with major depression as diagnosed by DSM-IV criteria for major depressive episode were treated with venlafaxine extended release for 12 weeks. Participants were recruited from July 2009 to January 2014. For each participant, we collected detailed data on prior antidepressant trials for the current episode of depression. We examined the prospective remission rates as a function of number and class of prior antidepressant trials in a post hoc analysis of pooled data from 2 prior trials. RESULTS: Remission rates with venlafaxine were inversely correlated with the number of prior adequate medication trials (66% for no prior adequate trials, 45% for 1 prior adequate trial, 23% for 2 or more prior adequate trials; P < .0001). Additionally, if prior treatment trials included a serotonin-norepinephrine reuptake inhibitor, participants were even less likely to achieve remission with venlafaxine (32% for 1 prior adequate trial, 18% for 2 or more prior adequate trials; P < .0001). Those with prior adequate trials were also more likely to require a higher dosage of venlafaxine to achieve remission. CONCLUSIONS: Information on an individual patient's number and class of prior adequate antidepressant trials can be used to predict the likelihood of a successful treatment outcome with a given antidepressant in older adults with major depression. Further work is needed to refine this approach to provide personalized antidepressant treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00892047 and NCT02263248.


Assuntos
Algoritmos , Antidepressivos/uso terapêutico , Regras de Decisão Clínica , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Cloridrato de Venlafaxina/uso terapêutico , Antidepressivos/efeitos adversos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/psicologia , Aripiprazol/efeitos adversos , Aripiprazol/uso terapêutico , Comorbidade , Preparações de Ação Retardada , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/psicologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Humanos , Funções Verossimilhança , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Cloridrato de Venlafaxina/efeitos adversos
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