Effectiveness and tolerability of switching to aripiprazole once monthly from antipsychotic polypharmacy and/or other long acting injectable antipsychotics for patients with schizophrenia in routine practice: a retrospective, observation study
Chi-Un Pae 1, 2, 3*, changsu Han 4, Won-Myong Bahk 1, Soo-Jung Lee 1, Ashwin Patkar 2, Prakash Masand 5
1Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea, 2Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA, 3Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea, 4Department of Psychiatry, Korea University, College of Medicine, Seoul, Republic of Korea, 5Global Medical Education, New York, NY, USA
Received: October 4, 2019; Revised: October 23, 2019; Accepted: November 6, 2019; Published online: November 6, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objectives: Aripiprazole once monthly (AOM) has been available in routine practice since 2013. Many well-controlled and naturalistic clinical studies have clearly proven its clinical efficacy and tolerability as short-term and long-term treatment options for treatment of schizophrenia. However, clinical data regarding patients who experienced switching to AOM from antipsychotic polypharmacy/other long acting injectable antipsychotics are not well-provided yet.
Methods: The observation was up to 12 months from the first use of AOM in patients with antipsychotic polypharmacy(APpoly)/other long acting injectable antipsychotics (LAIs) for treatment of schizophrenia in daily practice. Demographics and available clinical information such as The Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-severity (CGI-S) scores were retrieved from the electronic medical record (EMR). Adverse events were also noted as described in EMR.
Results: Eighteen patients were found to be switched from APpoly/LAIs. Mean numbers of previous APs treatment failure and immediate prior APs were 2.2 and 2.4, respectively; most commonly used APs before AOM were aripiprazole, blonanserin, quetiapine, and risperidone. Mean number of combined APs before AOM significantly decreased from 2.4 use to 0.7 at month 12 (P < 0.0001). The PANSS total (71.7 to 62.1, P=0.000) and CGI-S (3.4 to 3.1, P=0.008) scores were also significantly decreased from baseline (first use of AOM) to month 12, respectively. Other various psychotropics including anxiolytics were also significantly and substantially decreased at some point from baseline throughout the observation period as well. Mild hand tremor and akathisia were developed in 3 patients.
Conclusion: The present observation study clearly confirmed the use of AOM should be also effective and tolerable treatment option for patients with APpoly/LAIs in the real world practice. Subsequent, adequately-powered, and well-controlled clinical trials are warranted in near future.
Keywords: long acting injectable antipsychotic, aripiprazole once monthly, polypharmacy, schizophrenia, effectiveness, tolerability


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