Wednesday, January 30, 2019

Initiating Aripiprazole Similar to Other Antipsychotics When It Comes to Risk of Treatment Failure, Study Suggests

Patients who begin taking the antipsychotic aripiprazole after being treated with other antipsychotics do not appear to be at greater risk of hospitalization, self-harm, or suicide than those initiating other antipsychotics after previous antipsychotic exposure, according to a study reported today in JAMA Psychiatry.

Aripiprazole is an effective antipsychotic medication that is often used because it has fewer side effects compared with other antipsychotic medications, explained Fran├žois Montastruc, M.D., Ph.D., of the Jewish General Hospital in Quebec and colleagues. Recently, however, there have been reports that in patients already exposed to antipsychotic medication, aripiprazole can result in worsening of symptoms and treatment failure.

“We found no evidence of an increased rate of psychiatric treatment failure associated with initiating aripiprazole use compared with initiating use of other antipsychotic drugs in patients previously exposed to antipsychotic medications,” Montastruc and colleagues wrote.

They analyzed data from the United Kingdom Clinical Practice Research Datalink (CPRD) on 1,643 patients who were starting aripiprazole (either as a switch from or add-on to a previous antipsychotic medication) and another 1,643 patients who were starting on other oral antipsychotic medications under similar circumstances. The CPRD is one of the world’s largest computerized databases of anonymous primary care medical records, containing the data of more than 15 million patients enrolled with more than 700 general practices in the United Kingdom. Patients included those with diagnoses of schizophrenia, bipolar disorder, depression, “other psychiatric diseases,” or unknown.

Patients in both groups were matched on the basis of calendar year of cohort entry, time since first antipsychotic prescription, psychiatric disease history, age, and other factors. They were followed for one year or until psychiatric treatment failure or death from any cause other than suicide, whichever occurred first. The primary outcome was the first psychiatric treatment failure, defined as hospitalization for a psychiatric event, episode of self-harm, or suicide.

The researchers found that initiation of aripiprazole was not associated with an increased rate of overall psychiatric treatment failure, psychiatric hospitalizations, self-harm, or suicide compared with initiation of another antipsychotic medication.

“Switching to or adding aripiprazole may be associated with psychiatric worsening in some patients, but the findings suggest that these exacerbations do not lead to serious psychiatric treatment failure,” Montastruc and colleagues wrote. “These findings warrant replication in large observational studies.”

For related information, see the Psychiatric News article “Aripiprazole May Reduce Some Side Effects of Antipsychotics in Women.”

(Image: iStock/Minerva Studio)

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