Antipsychotic switching versus augmentation among early non-responders to risperidone or olanzapine in acute-phase schizophrenia

摘要

Purpose: We examined whether augmentation with olanzapine would be superior to switching to olanzapine among early non-responders (ENRs) to risperidone, and whether augmentation with risperidone would be superior to switching to risperidone among ENRs to olanzapine.We performed a rater-blinded, randomized clinical trial at psychiatric emergency sites. Eligible patients were newly admitted patients with acute schizophrenia. ENRs to the initial antipsychotic (Clinical Global Impressions-Improvement Scale: e. 4 at 2. weeks) were allocated to receive either augmentation with or switching to the other antipsychotic (RIS. +. OLZ vs. RIS-OLZ; OLZ. +. RIS vs. OLZ-RIS). Results: Sixty patients who completed 2. weeks of risperidone treatment were divided into 33 early responders (RIS-ER) and 27 ENRs (RIS. +. OLZ, n. =. 14; RIS-OLZ, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in RIS. +. OLZ group (54.1. days [95% confidence interval, 41.3-67.0]) than in RIS-ER group (68.7 [61.2-76.2]; P=. 0.050), it was not significantly shorter in RIS-OLZ group (58.5 [43.1-73.9]) than in RIS-ER group (P=. 0.19). Sixty patients who completed 2. weeks of olanzapine treatment were divided into 36 early responders (OLZ-ER) and 24 ENRs (OLZ. +. RIS, n. =. 11; OLZ-RIS, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in OLZ-RIS group (56.1. days [40.7-71.5]) than in OLZ-ER group (74.9 [68.5-81.3]; P=. 0.008), it was not significantly shorter in OLZ. +. RIS group (64.6 [49.6-79.6]) than in OLZ-ER group (P=. 0.20). Conclusion: Despite the lack of pharmacokinetic investigation of dose adequacy in this study, it is possible that switching to olanzapine among ENRs to risperidone might have a small advantage over augmentation with olanzapine, while augmentation with risperidone might have a small advantage over switching to risperidone among ENRs to olanzapine. Further research is required before it would be appropriate to modify routine practice in the direction of these findings.