Clinical consequences of switching from olanzapine to risperidone and vice versa in outpatients with schizophrenia: 36-month results from the worldwide schizophrenia outpatients health outcomes (W-SOHO) study
Por:
Hong J, Novick D, Brugnoli R, Karagianis J, Dossenbach M and Haro JM
Publicada:
4 dic 2012
Categoría:
Psychiatry and Mental Health
Resumen:
Background: With many atypical antipsychotics now available in the
market, it has become a common clinical practice to switch between
atypical agents as a means of achieving the best clinical outcomes. This
study aimed to examine the impact of switching from olanzapine to
risperidone and vice versa on clinical status and tolerability outcomes
in outpatients with schizophrenia in a naturalistic setting.
Methods: W-SOHO was a 3-year observational study that involved over
17,000 outpatients with schizophrenia from 37 countries worldwide. The
present post hoc study focused on the subgroup of patients who started
taking olanzapine at baseline and subsequently made the first switch to
risperidone (n=162) and vice versa (n=136). Clinical status was assessed
at the visit when the first switch was made (i.e. before switching) and
after switching. Logistic regression models examined the impact of
medication switch on tolerability outcomes, and linear regression models
assessed the association between medication switch and change in the
Clinical Global Impression-Schizophrenia (CGI-SCH) overall score or
change in weight. In addition, Kaplan-Meier survival curves and
Cox-proportional hazards models were used to analyze the time to
medication switch as well as time to relapse (symptom worsening as
assessed by the CGI-SCH scale or hospitalization).
Results: 48% and 39% of patients switching to olanzapine and
risperidone, respectively, remained on the medication without further
switches (p=0.019). Patients switching to olanzapine were significantly
less likely to experience relapse (hazard ratio: 3.43, 95% CI: 1.43,
8.26), extrapyramidal symptoms (odds ratio [OR]: 4.02, 95% CI: 1.49,
10.89) and amenorrhea/galactorrhea (OR: 8.99, 95% CI: 2.30, 35.13). No
significant difference in weight change was, however, found between the
two groups. While the CGI-SCH overall score improved in both groups
after switching, there was a significantly greater change in those who
switched to olanzapine (difference of 0.29 points, p=0.013).
Conclusion: Our study showed that patients who switched from risperidone
to olanzapine were likely to experience a more favorable treatment
course than those who switched from olanzapine to risperidone. Given the
nature of observational study design and small sample size, additional
studies are warranted.
Open Access
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