Peculiarities of personalized selection of antipsychotic drugs for schizophrenia treatment

Authors

DOI:

https://doi.org/10.26641/2307-0404.2024.1.300499

Keywords:

schizophrenia, primary psychotic episode, treatment, personalized approach, antipsychotics, olanzapine, orodispersible form

Abstract

Determining the optimal antipsychotic drugs, its effective dose, duration of therapy, form, and route of administration play a key role in the treatment of schizophrenia. In addition, special attention should be paid to the effectiveness of using different forms of antipsychotic drugs, in particular, the orally disintegrating form as exemplified by olanzapine. To study the peculiarities of a personalized approach in the use of antipsychotic drugs to achieve more effective results in treating schizophrenia, a content analysis was conducted using Ukrainian and English-language publications for the past 15 years. The search was conducted using the PubMed and CrossRef databases. An important conclusion is that the optimal therapeutic formula or drug should be selected individually, considering the specific patient's clinical condition. However, the most important factor in achieving successful results is the individually selected form and dose of the antipsychotic drugs. In addition to the patient's mental state, the choice of antipsychotic therapy is influenced by the spectrum of side effects, individual sensitivity to the active substance, pharmacological history, economic factors, etc. This is especially true for patients with insufficient adherence to treatment, which can often arise due to the side effects of drugs. In this case, it is important to correctly select both the active substance and the appropriate route of administration. Personalized selection of antipsychotic drugs also involves dynamic monitoring of changes in the patient's clinical condition, allowing for timely diagnosis of drug side effects, dose adjustments, or changes in the route of administration. These measures help increase patient adherence to treatment and improve their health-related quality of life.

References

Zhai J, Guo X, Chen M, Zhao J, Su Z. An investigation of economic costs of schizophrenia in two areas of China. Int J Ment Health Syst. 2013;7:26. doi: https://doi.org/10.1186/1752-4458-7-26

Wang L, Shi F, Guan X, Xu H, Liu J, Li H. A Systematic Review of Methods and Study Quality of Economic Evaluations for the Treatment of Schizophrenia. Front Public Health. 2021;9:689123. doi: https://doi.org/10.3389/fpubh.2021.689123

Mizuno Y, McCutcheon RA, Brugger SP, Howes OD. Heterogeneity and efficacy of antipsychotic treatment for schizophrenia with or without treatment resistance: a meta-analysis. Neuropsychopharmacology. 2020;45:622-31.

GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9:137-50. doi: https://doi.org/10.1016/S2215-0366(21)00395-3

Nucifora FC, Woznica E, Lee BJ, Cascella N, Sawa A. Treatment Resistant Schizophrenia: Clinical, Biological, and Therapeutic Perspectives. Neurobiol Dis. 2019;131:104257. doi: https://doi.org/10.1016/j.nbd.2018.08.016

Fond G, Falissard B, Nuss P, Collin C, Duret S, Rabbani M, et al. How can we improve the care of patients with schizophrenia in the real-world? A population-based cohort study of 456,003 patients. Mol Psychiatry. 2023 Jul 21:1-9. doi: https://doi.org/10.1038/s41380-023-02154-4

Asanova A, Khaustova O. Typical difficult situations in doctor-patient interactions. Psychosomatic Medicine and General Practice. 2018;3:e0303125. doi: https://doi.org/10.26766/pmgp.v3i3.125

Tiihonen J, Tanskanen A, Taipale H. 20-Year Nationwide Follow-Up Study on Discontinuation of Anti-psychotic Treatment in First-Episode Schizophrenia. Am J Psychiatry. 2018;175:765-73. doi: https://doi.org/10.1176/appi.ajp.2018.17091001

Asanova А. Personalized approach in the treatment of mental disorders: Long-term prospects for the use of low doses of psychotropic drugs. PMGP [Internet]. 2020 Aug 28 [cited 2023 Dec 3];5(2). Available from: https://e-medjournal.com/index.php/psp/article/view/239

Starzer M, Hansen HG, Hjorthøj C, Albert N, Nordentoft M, Madsen T. 20-year trajectories of positive and negative symptoms after the first psychotic episode in patients with schizophrenia spectrum disorder: results from the OPUS study. World Psychiatry. 2023;22:424-32. doi: https://doi.org/10.1002/wps.21121

Goff DC, Falkai P, Fleischhacker WW, Girgis RR, Kahn RM, Uchida H, et al. The Long-Term Effects of Antipsychotic Medication on Clinical Course in Schizophrenia. AJP 2017;174:840-9. doi: https://doi.org/10.1176/appi.ajp.2017.16091016

Demyttenaere K, Detraux J, Racagni G, Vans-teelandt K. Medication-Induced Akathisia with Newly Approved Antipsychotics in Patients with a Severe Mental Illness: A Systematic Review and Meta-Analysis. CNS Drugs. 2019;33:549-66. doi: https://doi.org/10.1007/s40263-019-00625-3

de Filippis R, Staltari FA, Aloi M, Carbone EA, Rania M, Destefano L, et al. Effectiveness of SGA-LAIs on Clinical, Cognitive, and Social Domains in Schi-zophrenia: Results from a Prospective Naturalistic Study. Brain Sci. 2023;13:577. doi: https://doi.org/10.3390/brainsci13040577

Sherzad Qadir Z, Ball PA, Morrissey H. Efficacy and Tolerance of Antipsychotics Used for the Treatment of Patients Newly Diagnosed with Schizophrenia: A Systematic Review and Meta-Analysis. Pharmacy (Basel). 2023;11:175. doi: https://doi.org/10.3390/pharmacy11060175

Moncrieff J, Gupta S, Horowitz MA. Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder. Ther Adv Psychopharmacol. 2020;10:2045125320937910. doi: https://doi.org/10.1177/2045125320937910

Sabe M, Zhao N, Crippa A, Kaiser S. Antipsychotics for negative and positive symptoms of schi-zophrenia: dose-response meta-analysis of randomized controlled acute phase trials. NPJ Schizophr. 2021;7:43. doi: https://doi.org/10.1038/s41537-021-00171-2

McAdam MK, Baldessarini RJ, Murphy AL, Gardner DM. Second International Consensus Study of Antipsychotic Dosing (ICSAD-2). J Psychopharmacol. 2023;37:982-91. doi: https://doi.org/10.1177/02698811231205688

Yu C-L, Carvalho AF, Thompson T, Tsai T-C, Tseng P-T, Hsu C-W, et al. Comparison of antipsychotic dose equivalents for acute bipolar mania and schi-zophrenia. BMJ Ment Health. 2023;26:e300546. doi: https://doi.org/10.1136/bmjment-2022-300546

Tani H, Takasu S, Uchida H, Suzuki T, Mimura M, Takeuchi H. Factors associated with successful antipsychotic dose reduction in schizophrenia: a systematic review of prospective clinical trials and meta-analysis of randomized controlled trials. Neuropsychopharmacol. 2020;45:887-901. doi: https://doi.org/10.1038/s41386-019-0573-7

Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med. 2021;12:443-52. doi: https://doi.org/10.1007/s41999-021-00479-3

Bozzatello P, Bellino S, Rocca P. Predictive Factors of Treatment Resistance in First Episode of Psychosis: A Systematic Review. Front Psychiatry. 2019;10:67. doi: https://doi.org/10.3389/fpsyt.2019.00067

Joo SW, Kim H, Jo YT, Ahn S, Choi YJ, Choi W, et al. Comparative effectiveness of antipsychotic mono-therapy and polypharmacy in schizophrenia patients with clozapine treatment: A nationwide, health insurance data-based study. Eur Neuropsychopharmacol. 2022;59:36-44. doi: https://doi.org/10.1016/j.euroneuro.2022.03.010

Leucht S, Schneider‐Thoma J, Burschinski A, Pe-ter N, Wang D, Dong S, et al. Long‐term efficacy of antipsychotic drugs in initially acutely ill adults with schizophrenia: systematic review and network meta‐analysis. World Psychiatry. 2023;22:315-24. doi: https://doi.org/10.1002/wps.21089

Stroup TS, Gray N. Management of common ad-verse effects of antipsychotic medications. World Psychiatry. 2018;17:341-56. doi: https://doi.org/10.1002/wps.20567

Yoshida K, Takeuchi H. Dose-dependent effects of antipsychotics on efficacy and adverse effects in schi-zophrenia. Behavioural Brain Research. 2021;402:113098. doi: https://doi.org/10.1016/j.bbr.2020.113098

Foster A, King J. Antipsychotic Polypharmacy. Focus (Am Psychiatr Publ). 2020;18:375-85. doi: https://doi.org/10.1176/appi.focus.20190047

Valsecchi P, Garozzo A, Nibbio G, Barlati S, Deste G, Turrina C, et al. Paliperidone extended-release in the short- and long-term treatment of schizophrenia. Riv Psichiatr. 2019;54:43-58. doi: https://doi.org/10.1708/3142.31245

Paris G, Bighelli I, Deste G, Siafis S, Schneider-Thoma J, Zhu Y, et al. Short-acting intramuscular second-generation antipsychotic drugs for acutely agitated patients with schizophrenia spectrum disorders. A systematic review and network meta-analysis. Schizophrenia Research. 2021;229:3-11. doi: https://doi.org/10.1016/j.schres.2021.01.021

Kolli P, Kelley G, Rosales M, Faden J, Serdenes R. Olanzapine Pharmacokinetics: A Clinical Review of Current Insights and Remaining Questions. Pharmge-nomics Pers Med. 2023;16:1097-108. doi: https://doi.org/10.2147/PGPM.S391401

Ostuzzi G, Bertolini F, Del Giovane C, Tedeschi F, Bovo C, Gastaldon C, et al. Maintenance Treatment With Long-Acting Injectable Antipsychotics for People With Nonaffective Psychoses: A Network Meta-Analysis. Am J Psychiatry. 2021;178:424-36. doi: https://doi.org/10.1176/appi.ajp.2020.20071120

Kraemer S, Chartier F, Augendre-Ferrante B, Psarra V, D’yachkova Y, Beselin A, et al. Effectiveness of two formulations of oral olanzapine in patients with schizophrenia or bipolar disorder in a natural setting: results from a 1-year European observational study. Hum Psychopharmacol. 2012;27:284-94. doi: https://doi.org/10.1002/hup.2224

Novick D, Montgomery W, Treuer T, Koyanagi A, Aguado J, Kraemer S, et al. Comparison of clinical outcomes with orodispersible versus standard oral olan-zapine tablets in nonadherent patients with schizophrenia or bipolar disorder. Patient Prefer Adherence. 2017;11:1019-25. doi: https://doi.org/10.2147/PPA.S124581

Kishimoto T, Hagi K, Nitta M, Kane JM, Cor-rell CU. Long‐term effectiveness of oral second‐generation antipsychotics in patients with schizophrenia and related disorders: a systematic review and meta‐analysis of direct head‐to‐head comparisons. World Psychiatry. 2019;18:208-24. doi: https://doi.org/10.1002/wps.20632

Zhao J, Jiang K, Li Q, Zhang Y, Cheng Y, Lin Z, et al. Cost-effectiveness of olanzapine in the first-line treatment of schizophrenia in China. J Med Econ. 2019;22:439-46. doi: https://doi.org/10.1080/13696998.2019.1580714

Ascher-Svanum H, Furiak NM, Lawson AH, Klein TM, Smolen LJ, Conley RR, et al. Cost-effectiveness of several atypical antipsychotics in orally disintegrating tablets compared with standard oral tablets in the treatment of schizophrenia in the United States. J Med Econ. 2012;15:531-47. doi: https://doi.org/10.3111/13696998.2012.662923

Perkins AJ, Khandker R, Overley A, Solid CA, Chekani F, Roberts A, et al. The impact of antipsychotic adherence on acute care utilization. BMC Psychiatry. 2023;23:64. doi: https://doi.org/10.1186/s12888-023-04558-6

Stürup AE, Nordentoft M, Jimenez-Solem E, Osler M, Davy JW, Christensen TN, et al. Discontinuation of antipsychotics in individuals with first-episode schi-zophrenia and its association to functional outcomes, hospitalization and death: a register-based nationwide follow-up study. Psychological Medicine. 2023;53:5033-41. doi: https://doi.org/10.1017/S0033291722002021

Xiao J, Mi W, Li L, Shi Y, Zhang H. High relapse rate and poor medication adherence in the Chinese popu-lation with schizophrenia: results from an observational survey in the People’s Republic of China. Neuropsychiatr Dis Treat. 2015;11:1161-7. doi: https://doi.org/10.2147/NDT.S72367

Weiden PJ, Kozma C, Grogg A, Locklear J. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr Serv. 2014;55:886-91. doi: https://doi.org/10.1176/appi.ps.55.8.886

Vidarsdottir S, Roelfsema F, Streefland T, Holst JJ, Rehfeld JF, Pijl H. Shortterm treatment with olanzapine does not modulate gut hormone secretion: olanzapine disin¬tegrating versus standard tablets. Eur J Endocrinol. 2010;162:75-83. doi: https://doi.org/10.1530/EJE-09-0433

Kusumi I, Honda M, Uemura K, Sugawara Y, Kohsaka M, Tochigi A, et al. Effect of olanzapine orally disintegrating tablet versus oral standard tablet on body weight in patients with schizophrenia: a randomized open-label trial. Prog Neuropsychopharmacol Biol Psychiatry. 2012;36:313-7. doi: https://doi.org/10.1016/j.pnpbp.2011.11.004

Weston-Green K, Huang X-F, Lian J, Deng C. Ef-fects of olanzapine on muscarinic M3 receptor binding density in the brain relates to weight gain, plasma insulin and metabolic hormone levels. Eur Neuropsychopharmacol. 2012;22:364-73. doi: https://doi.org/10.1016/j.euroneuro.2011.09.003

Pandey A, Kalita KN. Treatment-resistant schizo-phrenia: How far have we traveled? Front Psychiatry. 2022;13:994425. doi: https://doi.org/10.3389/fpsyt.2022.994425

Antosik-Wójcińska A. Olanzapine ODT – who is this alternative for? A simple guide in questions and ans-wers. Psychiatria Spersonalizowana. 2022;1(2):88-91.

Hobbs D, Karagianis J, Treuer T, Raskin J. An in vitro analysis of disintegration times of different formu-lations of olanzapine orodispersible tablet: a preliminary report. Drugs R D. 2013;13:281-8. doi: https://doi.org/10.1007/s40268-013-0030-8

Published

2024-04-01

How to Cite

1.
Khaustova O, Asanova A, Dzeruzhynska N, Matiash M. Peculiarities of personalized selection of antipsychotic drugs for schizophrenia treatment. Med. perspekt. [Internet]. 2024Apr.1 [cited 2024Jun.30];29(1):43-52. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/300499

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Section

THEORETICAL MEDICINE