Abstract
Methods: A rigorous comparative analysis of antipsychotics used for treating schizophrenia was conducted to determine their relative efficacy, risk of all-cause discontinuations, reasons for discontinuation and potential side effects. A systematic review was developed following PRISMA-P guidelines, the RevMan statistical analysis tool and the Effective Public Health Practice Project (EPHPP) methodological rating tool to assess the quality of included studies. The primary outcome of interest was the difference in overall clinical efficacy between various antipsychotic medications. Then a survey of psychiatrists from the UK and India was conducted to understand their opinions regarding their choice of antipsychotic medications, their experience with tolerance and efficacy in managing psychosis. The survey was open for three months, from 26 April 2022 to 31 July 2022.
Results: Aripiprazole was found to have significantly fewer long-term side effects than ziprasidone (p= 0.008, NNH=27, RR=0.84, CI=0.74-0.96) and quetiapine (p= 0.009, NNH=38, RR=0.79, CI=0.66-0.94). Quetiapine was found to have a significant advantage over ziprasidone in long-term treatment-emergent akathisia (p= 0.005, NNH=7, RR=1.87, CI=1.21‒2.90). The long-term treatment of akathisia between olanzapine and haloperidol showed significant differences, with haloperidol being significantly favoured in weight gain (p< 0.00001, NNH=4, RR=1.56, CI=1.31‒1.86), and olanzapine being significantly favoured in treatment akathisia (p= 0.002, NNH=6, RR=3.09, CI=1.49‒6.39). Moreover, the forest plot outcomes for treatment akathisia showed a significant advantage of quetiapine over haloperidol (p= 0.02, NNH=8, RR=1.80, CI=1.08‒3). Additionally, weight gain was significantly better in ziprasidone than against both haloperidol (p= 0.04, NNH=6, RR=1.45, CI=1.03‒2.04) and olanzapine (p< 0.00001, NNH=2, RR=2.27, CI=1.69‒3.03) in long-term analysis. In the long-term analysis, olanzapine (p= 0.001, NNT=17, RR=0.67, CI (0.53‒0.85)) and ziprasidone (p= 0.003, NNT=17, RR=1.47, CI=1.14‒1.90) were found to have significantly lower discontinuation rates than haloperidol, with longer time to discontinuation.The survey showed that Olanzapine, Risperidone, and Aripiprazole remain popular antipsychotic medications in India and the UK. The primary consideration for prescribing, switching, or adding a second antipsychotic was efficacy, and psychiatrists preferred adding a second medication after 4‒6 weeks (28.4%) or 3‒6 months (24.2%). Illicit drug use was the main cause of relapse among patients who had discontinued antipsychotics. Non-adherence to treatment was also identified as the main challenge in treating psychosis, using long-acting injectable (LAI) formulations of antipsychotics preferred over oral formulations. Indian psychiatrists reported greater acceptance of LAIs among patients (57%) than their UK counterparts (36%). Non-adherence was the leading cause of hospitalisation, and illicit drug use was the primary cause of relapse. Weight gain was the most commonly reported troublesome side effect causing poor adherence. Psychiatrists also reported weight gain as the most common reason for switching antipsychotic medications and the most common side effect leading them to seek termination of treatment patients.
Conclusions: The analysis revealed more pronounced variations relating to side effects compared to efficacy. The findings have important implications for selecting and managing antipsychotic treatment for individuals with psychiatric disorders and inform the development of tailored treatment plans for patients, optimising their overall treatment outcomes.
Results: Aripiprazole was found to have significantly fewer long-term side effects than ziprasidone (p= 0.008, NNH=27, RR=0.84, CI=0.74-0.96) and quetiapine (p= 0.009, NNH=38, RR=0.79, CI=0.66-0.94). Quetiapine was found to have a significant advantage over ziprasidone in long-term treatment-emergent akathisia (p= 0.005, NNH=7, RR=1.87, CI=1.21‒2.90). The long-term treatment of akathisia between olanzapine and haloperidol showed significant differences, with haloperidol being significantly favoured in weight gain (p< 0.00001, NNH=4, RR=1.56, CI=1.31‒1.86), and olanzapine being significantly favoured in treatment akathisia (p= 0.002, NNH=6, RR=3.09, CI=1.49‒6.39). Moreover, the forest plot outcomes for treatment akathisia showed a significant advantage of quetiapine over haloperidol (p= 0.02, NNH=8, RR=1.80, CI=1.08‒3). Additionally, weight gain was significantly better in ziprasidone than against both haloperidol (p= 0.04, NNH=6, RR=1.45, CI=1.03‒2.04) and olanzapine (p< 0.00001, NNH=2, RR=2.27, CI=1.69‒3.03) in long-term analysis. In the long-term analysis, olanzapine (p= 0.001, NNT=17, RR=0.67, CI (0.53‒0.85)) and ziprasidone (p= 0.003, NNT=17, RR=1.47, CI=1.14‒1.90) were found to have significantly lower discontinuation rates than haloperidol, with longer time to discontinuation.The survey showed that Olanzapine, Risperidone, and Aripiprazole remain popular antipsychotic medications in India and the UK. The primary consideration for prescribing, switching, or adding a second antipsychotic was efficacy, and psychiatrists preferred adding a second medication after 4‒6 weeks (28.4%) or 3‒6 months (24.2%). Illicit drug use was the main cause of relapse among patients who had discontinued antipsychotics. Non-adherence to treatment was also identified as the main challenge in treating psychosis, using long-acting injectable (LAI) formulations of antipsychotics preferred over oral formulations. Indian psychiatrists reported greater acceptance of LAIs among patients (57%) than their UK counterparts (36%). Non-adherence was the leading cause of hospitalisation, and illicit drug use was the primary cause of relapse. Weight gain was the most commonly reported troublesome side effect causing poor adherence. Psychiatrists also reported weight gain as the most common reason for switching antipsychotic medications and the most common side effect leading them to seek termination of treatment patients.
Conclusions: The analysis revealed more pronounced variations relating to side effects compared to efficacy. The findings have important implications for selecting and managing antipsychotic treatment for individuals with psychiatric disorders and inform the development of tailored treatment plans for patients, optimising their overall treatment outcomes.
Original language | English |
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Pages | 20-21 |
Number of pages | 2 |
Publication status | Published - 2023 |
Event | FIP Pharmacy Practice Research summer meeting 2023: for PhD students, postdoctoral fellows and supervisors - University of Granada, Granada, Spain Duration: 03 Jul 2023 → 04 Jul 2023 https://fip.eventsair.com/2023-ppr-summer-meeting/ https://pharmacyeducation.fip.org/pharmacyeducation/article/view/2435/1595 (Published abstracts) |
Other
Other | FIP Pharmacy Practice Research summer meeting 2023 |
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Country/Territory | Spain |
City | Granada |
Period | 03/07/23 → 04/07/23 |
Other | The FIP Pharmacy Practice Research Special Interest Group (PPR SIG), in collaboration with University of Granada, is hosting an international event — “Pharmacy practice research summer meeting for PhD students, postdoctoral fellows and supervisors” — on 3 and 4 July 2023 in Granada, Spain. The main scope of the PPR SIG is to increase pharmacy practice contributions to global health by providing greater access to the latest high-quality international pharmacy practice research. During this meeting both starting-out and experienced researchers will be able to collaborate on major PPR themes. PhD students and their supervisors, researchers, academics, professional organisations and practitioners involved in research are welcome to join this face-to-face meeting to present their work and to start building new global pharmacy networks. Accepted abstracts will be published in the Pharmacy Education journal. Selected authors will be invited to present their work either through poster or oral presentation and interact with the audience during the event. The best presentations will receive an award. Certificates of attendance and presentations will be provided. |
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