Early antipsychotic response to aripiprazole in adolescents with schizophrenia:
predictive value for clinical outcomes.
Author(s): Correll CU(1), Zhao J, Carson W, Marcus R, McQuade R, Forbes RA, Mankoski R.
Affiliation(s): Author information:
(1)Zucker Hillside Hospital, Hofstra North Shore Long Island Jewish School of
Medicine, Glen Oaks, NY 11004, USA. ccorrell@lij.edu
Publication date & source: 2013, J Am Acad Child Adolesc Psychiatry. , 52(7):689-698
OBJECTIVE: In adults with chronic schizophrenia, most symptom decreases occur in
the first few weeks of antipsychotic treatment, and nonresponse at week 2
predicts a later nonresponse. The trajectory of antipsychotic response and the
predictive value of early antipsychotic effects were investigated for ultimate
outcome in adolescent schizophrenia, where such data are still lacking.
METHOD: This post hoc analysis of a 6-week, randomized, double-blinded trial of
aripiprazole (n = 196) versus placebo (n = 98) evaluated if adolescents 13 to 17
years old with schizophrenia exhibited substantial symptomatic improvement to
aripiprazole in the first few treatment weeks and whether early response (ER)
versus early nonresponse (ENR) predicted clinically relevant outcomes. ER
decreased at least 20% and ENR decreased less than 20% in Positive and Negative
Syndrome Scale (PANSS) total score at week 2 (ER2/ENR2) or 3 (ER3/ENR3). Ultimate
response decreased at least 40% in PANSS score.
RESULTS: Nearly 50% of the PANSS decrease was achieved by week 2 and up to 75% by
week 3. ER2/ER3 subjects showed significantly greater improvement than ENR
subjects in PANSS total score, PANSS positive and negative subscale scores, and
functionally relevant outcomes. In general, ER3 had better sensitivity,
specificity, and positive and negative predictive values than ER2 for predicting
ultimate response. ER2 subjects were 8.8 times (95% confidence interval 4.0-19.4)
and ER3 subjects were 8.6 times (95% confidence interval 4.5-16.6) more likely to
achieve remission at week 6 (p < .0001) than ENR2 and ENR3 subjects,
respectively, although adverse events were similar.
CONCLUSIONS: Like adults with chronic schizophrenia, adolescents with early-phase
schizophrenia exhibited most symptomatic improvement early during aripiprazole
treatment, with week 3 improvements having the best predictive power. Although
requiring extension, these results may inform clinical decision making. Clinical
trial registration information-Aripiprazole in Adolescents with Schizophrenia,
http://clinicaltrials.gov/, NCT00102063.
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