Lack of tolerable treatment options for patients with schizophrenia

Leslie Citrome,1 Anna Eramo,2 Clement Francois,2 Ruth Duffy,3 Susan N Legacy,3 Steve J Offord,3 Holly B Krasa,3 Stephen S Johnston,4 Alice Guiraud-Diawara,5 Siddhesh A Kamat,3 Patricia Rohman3 1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, 2Lundbeck, Deer...

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Autores principales:	Citrome L, Eramo A, Francois C, Duffy R, Legacy SN, Offord SJ, Krasa HB, Johnston SS, Guiraud-Diawara A, Kamat SA, Rohman P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	schizophrenia atypical antipsychotics tolerability comorbidities treatment Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/f52fce680c02433a94e07a79f62deb18
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spelling	oai:doaj.org-article:f52fce680c02433a94e07a79f62deb182021-12-02T03:59:27ZLack of tolerable treatment options for patients with schizophrenia1178-2021https://doaj.org/article/f52fce680c02433a94e07a79f62deb182015-12-01T00:00:00Zhttps://www.dovepress.com/lack-of-tolerable-treatment-options-for-patients-with-schizophrenia-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Leslie Citrome,1 Anna Eramo,2 Clement Francois,2 Ruth Duffy,3 Susan N Legacy,3 Steve J Offord,3 Holly B Krasa,3 Stephen S Johnston,4 Alice Guiraud-Diawara,5 Siddhesh A Kamat,3 Patricia Rohman3 1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, 2Lundbeck, Deerfield, IL, 3Otsuka America Pharmaceuticals, Princeton, NJ, 4Truven Health Analytics, Bethesda, MD, USA; 5Lundbeck SAS, Issy-les-Moulineaux, France Purpose: Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods: AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results: A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined. Conclusion: When combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy. Keywords: schizophrenia, atypical antipsychotics, tolerability, comorbidities, treatmentCitrome LEramo AFrancois CDuffy RLegacy SNOfford SJKrasa HBJohnston SSGuiraud-Diawara AKamat SARohman PDove Medical Pressarticleschizophreniaatypical antipsychoticstolerabilitycomorbiditiestreatmentNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2015, Iss Issue 1, Pp 3095-3104 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	schizophrenia atypical antipsychotics tolerability comorbidities treatment Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	schizophrenia atypical antipsychotics tolerability comorbidities treatment Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Citrome L Eramo A Francois C Duffy R Legacy SN Offord SJ Krasa HB Johnston SS Guiraud-Diawara A Kamat SA Rohman P Lack of tolerable treatment options for patients with schizophrenia
description	Leslie Citrome,1 Anna Eramo,2 Clement Francois,2 Ruth Duffy,3 Susan N Legacy,3 Steve J Offord,3 Holly B Krasa,3 Stephen S Johnston,4 Alice Guiraud-Diawara,5 Siddhesh A Kamat,3 Patricia Rohman3 1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, 2Lundbeck, Deerfield, IL, 3Otsuka America Pharmaceuticals, Princeton, NJ, 4Truven Health Analytics, Bethesda, MD, USA; 5Lundbeck SAS, Issy-les-Moulineaux, France Purpose: Atypical antipsychotics (AAs), an effective treatment for schizophrenia, have a range of pharmacologic properties leading to differences in tolerability as well as heterogeneity in treatment response. Individual patient characteristics must be considered when making treatment choices, especially from an adverse event (AE) or tolerability perspective. Despite the availability of numerous AAs, after appraising patient characteristics at the time of treatment selection, physicians may quickly run out of tolerable treatment options. Patients and methods: AE risk factors, defined as having either a prior history of an AE or a risk factor for that AE, were determined for Medicaid-insured and Commercially insured patients using database analysis. Patients receiving AA treatment between January 1, 2010 and December 31, 2012 defined the index date of first observed AA prescription during this period. Nine AAs were evaluated for association with AE risk factors as informed by drug prescribing information from the different manufacturers and published meta-analyses. The proportion of patients with pre-index AE risk factors prescribed an AA associated with that risk factor was then determined. Results: A high proportion of patients (>80%) were prescribed an AA associated with extrapyramidal symptoms or akathisia despite experiencing extrapyramidal symptoms or akathisia prior to AA treatment initiation. Similar trends were observed among patients with diabetes (>60%) and obesity (>40%). From the nine treatment options available, the number of optimal choices for individual patient segments were limited based on their prior history, including those with cardiometabolic and cardiovascular comorbidities (four); experiencing prolactin elevation-related problems (seven); needing to avoid excessive sedation (four); or at risk of extrapyramidal symptoms or akathisia (two). Options were then further restricted among patients in more than one segment when multiple pre-index AE risk factors were combined. Conclusion: When combining patient risk profile with antipsychotic AE profile, physicians may quickly run out of tolerable treatment options for individual patients, despite the availability of many AAs, suggesting a need for additional treatment options with better tolerability and without compromising efficacy. Keywords: schizophrenia, atypical antipsychotics, tolerability, comorbidities, treatment
format	article
author	Citrome L Eramo A Francois C Duffy R Legacy SN Offord SJ Krasa HB Johnston SS Guiraud-Diawara A Kamat SA Rohman P
author_facet	Citrome L Eramo A Francois C Duffy R Legacy SN Offord SJ Krasa HB Johnston SS Guiraud-Diawara A Kamat SA Rohman P
author_sort	Citrome L
title	Lack of tolerable treatment options for patients with schizophrenia
title_short	Lack of tolerable treatment options for patients with schizophrenia
title_full	Lack of tolerable treatment options for patients with schizophrenia
title_fullStr	Lack of tolerable treatment options for patients with schizophrenia
title_full_unstemmed	Lack of tolerable treatment options for patients with schizophrenia
title_sort	lack of tolerable treatment options for patients with schizophrenia
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/f52fce680c02433a94e07a79f62deb18
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Lack of tolerable treatment options for patients with schizophrenia

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