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Difference in early prediction of antipsychotic non-response between risperidone and olanzapine in the treatment of acute-phase schizophrenia.

Author(s): Hatta K, Otachi T, Sudo Y, Hayakawa T, Ashizawa Y, Takebayashi H, Hayashi N, Hamakawa H, Ito S, Nakase R, Usui C, Nakamura H, Hirata T, Sawa Y

Affiliation(s): Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan. khatta@juntendo.ac.jp

Publication date & source: 2011-05, Schizophr Res., 128(1-3):127-35. Epub 2011 Mar 21.

Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

PURPOSE: We examined whether early response/non-response to risperidone according to the Clinical Global Impressions-improvement scale (CGI-I) at 2 weeks could predict subsequent response. This prediction was also applied to olanzapine. We then investigated whether early non-responders (ENRs) to risperidone or olanzapine who switched to the other showed significantly greater improvement, compared with those staying on the initial antipsychotic. We performed a rater-blinded, randomized controlled trial in 18 psychiatric emergency sites. Eligible patients were newly admitted patients with acute schizophrenia. Early response was defined as CGI-I </= 3 following 2 weeks of treatment. The primary outcome measure was achievement of remission and >/= 50% improvement in the Positive and Negative Syndrome Scale at 4 weeks. RESULTS: At 4 weeks, 53% of risperidone early responders (ERs) went into remission, whereas only 9% of ENRs staying on risperidone (n=11) did (P=0.016). Similarly, at 4 weeks, 81% of risperidone ERs achieved >/= 50% response, whereas only 9% of ENRs staying on risperidone achieved >/= 50% response (P < 0.0001). In contrast, 58% of olanzapine ERs (n=33) went into remission, whereas 38% of ENRs staying on olanzapine (n=8) did at 4 weeks (P=0.44). Similarly, 61% of olanzapine ERs achieved >/= 50% response, whereas 25% of ENRs staying on olanzapine achieved >/= 50% response (P=0.12). The negative likelihood ratio for the prediction of >/= 50% response at 4 weeks by early response status to risperidone at 2 weeks was 0.057. CONCLUSION: In newly admitted patients with acute schizophrenia, non-response to risperidone using CGI-I at 2 weeks can predict subsequent response. It looks like there is significant response to olanzapine that doesn't occur until 4 weeks. Thus, clinicians may want to switch to another drug earlier when risperidone is the first drug, and later when olanzapine is the first drug. Copyright (c) 2011 Elsevier B.V. All rights reserved.

Page last updated: 2011-12-09

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