Clinical benefit and utility of switching to aripiprazole once monthly in patients with antipsychotic polypharmacy or 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 A Patkar 2, Prakash S 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 24, 2019; Revised: December 9, 2019; Accepted: December 18, 2019; Published online: December 18, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objectives: In a number of controlled clinical trials and naturalistic studies, aripiprazole once monthly (AOM) has been found to be effective and safe as acute and maintenance treatment options for schizophrenia. However, such clinical data have been presented in selected patient population (i.e., antipsychotic monotherapy, e.t.c.), in particular, clinical information on switching to AOM from antipsychotic polypharmacy and/or other long acting injectable antipsychotics (LAIs) has been scarce till today.
Methods: The study period was from the first switching day to AOM up to 12 months in patients with antipsychotic polypharmacy(APpoly)/LAIs (baseline, month 3, month 6, and month 12). Available demographics and clinical information were retrieved from electronic medical records (EMRs). Available scores of Global Assessment of Functioning (GAF), Clinical Global Impression-Clinical Benefit (CGI-S/-CB), CGI-severity, Visual Analog Scale on Satisfaction-Patient/Health Professional (VAS-P/HP), and the Positive and Negative Syndrome Scale-Insight(PANSS-I) scores were also taken from EMR. Proportional change of functional impairment before and after AOM was also captured.
Results: Data of 18 patients were available. Most commonly used combined APs before AOM were aripiprazole, blonanserin, quetiapine, and risperidone. At least 2 APs (N=2.4) were combined before AOM. Scores of GAF (10.7% increase), CGI-CB (46.2% decrease), VAS-P (47.8% increase), VAS-HP (40.8% increase), and PANSS-I (27.9% increase) (all P=0.001) were significantly improved from baseline to month 12, respectively. Approximately 59% of patients improved individual functioning with different level (i.e., employment, back to school, e.t.c.) after AOM treatment at month 12.
Conclusion: The present study have clearly shown the clinical benefit and utility of switching to AOM for treatment of patients with APpoly/LAIs in routine practice. Subsequent, adequately-powered, well-controlled clinical trials may be necessary to confirm our findings in near future.
Keywords: aripiprazole once monthly, long-acting injectable antipsychotics, antipsychotic polypharmacy, clinical utility, clinical benefit, functioning, schizophrenia


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