Exploring Hidden Issues in the Use of Antipsychotic Polypharmacy in the Treatment of Schizophrenia
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The mainstay of schizophrenia treatment is pharmacological therapy using various antipsychotics including first- and second-generation antipsychotics which have different pharmacokinetic and pharmacodynamic property leading to differential presentation of adverse events (AEs) and treatment effects such as negative symptoms, cognitive symptoms and cormorbid symptoms. Major treatment guidelines suggest the use of antipsychotic monotherapy (APM) as a gold standard in the treatment of schizophrenia. However, the effects of APM is inadequate and less potent to achieve symptom remission as well as functional recovery in real practice which has been consistently reported in numerous controlled clinical trials, large practical trials, independent small studies and systematic reviews till today. Therefore antipsychotic polypharmacy (APP) regardless of the class of antipsychotics has been also commonly utilized for many reasons in real world practice. However, APP has also crucial pitfalls including increase of total psychotics including antipsychotics, high-doses of antipsychotics used, poor compliance, drug-drug interaction and risks for developing AEs, all of which are paradoxically related to poor clinical outcomes, whereas APP has also substantial advantages in reduction of re-hospitalization, severe psychopathology and targeted control of concurrent symptoms. Given currently limited therapeutic options, it is also important to properly utilize APP in order to maximize its clinical utility and minimize its risk for better treatment outcomes for patients with schizophrenia, based on risk/benefit with full understanding of pharmacological and clinical issues on APP. The present paper intends to address intriguing and important issues in the use of APP in real world practice.
Abstract
The mainstay of schizophrenia treatment is pharmacological therapy using various antipsychotics including first- and second-generation antipsychotics which have different pharmacokinetic and pharmacodynamic property leading to differential presentation of adverse events (AEs) and treatment effects such as negative symptoms, cognitive symptoms and cormorbid symptoms. Major treatment guidelines suggest the use of antipsychotic monotherapy (APM) as a gold standard in the treatment of schizophrenia. However, the effects of APM is inadequate and less potent to achieve symptom remission as well as functional recovery in real practice which has been consistently reported in numerous controlled clinical trials, large practical trials, independent small studies and systematic reviews till today. Therefore antipsychotic polypharmacy (APP) regardless of the class of antipsychotics has been also commonly utilized for many reasons in real world practice. However, APP has also crucial pitfalls including increase of total psychotics including antipsychotics, high-doses of antipsychotics used, poor compliance, drug-drug interaction and risks for developing AEs, all of which are paradoxically related to poor clinical outcomes, whereas APP has also substantial advantages in reduction of re-hospitalization, severe psychopathology and targeted control of concurrent symptoms. Given currently limited therapeutic options, it is also important to properly utilize APP in order to maximize its clinical utility and minimize its risk for better treatment outcomes for patients with schizophrenia, based on risk/benefit with full understanding of pharmacological and clinical issues on APP. The present paper intends to address intriguing and important issues in the use of APP in real world practice.
참고문헌 (65)
- "Psychosis and schizophrenia in adults: prevention and management" (2014)[URL]
- Jung Suk Lee, "Korean Medication Algorithm for Schizophrenia 2019, Second Revision: Treatment of Psychotic Symptoms", Clinical Psychopharmacology and Neuroscience, 18(3), pp.386~394 (2020), 대한정신약물학회[DOI]
- Hasan A, "World Federation of Societies of Biological Psychiatry(WFSBP)Guidelines for Biological Treatment of Schizophrenia, part 1 : update 2012 on the acute treatment of schizophrenia and the management of treatment resistance", World J Biol Psychiatry, 13, pp.318~378 (2012)
- Barnes TR, "Evidence-based guidelines for the pharmacological treatment of schizophrenia : updated recommendations from the British Association for Psychopharmacology", J Psychopharmacol, 34, pp.3~78 (2020)
- Galletly C, "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders", Aust N Z J Psychiatry, 50, pp.410~472 (2016)
- Lehman AF, "Practice guideline for the treatment of patients with schizophrenia, second edition", Am J Psychiatry, 161(2 Suppl), pp.1~56 (2004)
- Remington G, "Guidelines for the pharmacotherapy of schizophrenia in adults", Can J Psychiatry, 62, pp.604~616 (2017)
- Stahl SM, "Emerging guidelines for the use of antipsychotic polypharmacy", Rev Psiquiatr Salud Ment, 6, pp.97~100 (2013)
- Keepers GA, "The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia", Am J Psychiatry, 177, pp.868~872 (2020)
- Chi-Un Pae, "Consideration of Long-Acting Injectable Antipsychotics for Polypharmacy Regimen in the Treatment of Schizophrenia: Put It on the Table or Not?", Clinical Psychopharmacology and Neuroscience, 19(3), pp.434~448 (2021), 대한정신약물학회[DOI]
- Mojtabai R, "National trends in psychotropic medication polypharmacy in office-based psychiatry", Arch Gen Psychiatry, 67, pp.26~36 (2010)
- Freudenreich O, "Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations", Acta Psychiatr Scand, 106, pp.323~330 (2002)
- Lin SK, "Antipsychotic polypharmacy: a dirty little secret or a fashion?", Int J Neuropsychopharmacol, 23, pp.125~131 (2020)
- Gallego JA, "Prevalence and correlates of antipsychotic polypharmacy : a systematic review and meta-regression of global and regional trends from the 1970s to 2009", Schizophr Res, 138, pp.18~28 (2012)
- Jeong Ha Park, "Effects of Amisulpride Adjunctive Therapy on Working Memory and Brain Metabolism in the Frontal Cortex of Patients with Schizophrenia: A Preliminary Positron Emission Tomography", Computerized Tomography Investigation, 2019, pp.17(2), 250~260[DOI]
- José Andrés Espejo Oltra, "Improving Therapeutic Interventions of Schizophrenia with Advances in Stem Cell Technology", Clinical Psychopharmacology and Neuroscience, 18(3), pp.352~361 (2020), 대한정신약물학회[DOI]
- Dong M, "Prescription of antipsychotic and concomitant medications for adult Asian schizophrenia patients : findings of the 2016 Research on Asian Psychotropic Prescription Patterns(REAP)survey", Asian J Psychiatr, 45, pp.74~80 (2019)
- Hatta K, "Real-world effectiveness of antipsychotic monotherapy and polytherapy in 1543 patients with acute-phase schizophrenia", Asian J Psychiatr, 40, pp.82~87 (2019)
- Guinart D, "Antipsychotic polypharmacy in schizophrenia: why not?", J Clin Psychiatry, 81, pp.19~ (2020)
- Sun F, "Polypharmacy with antipsychotic drugs in patients with schizophrenia : trends in multiple health care systems", Am J Health Syst Pharm, 71, pp.728~738 (2014)
- Galling B, "Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and metaregression analysis", World Psychiatry, 16, pp.77~89 (2017)
- Tiihonen J, "Association of antipsychotic polypharmacy vs monotherapy with psychiatric rehospitalization among adults with schizophrenia", JAMA Psychiatry, 76, pp.499~507 (2019)
- Roh D, "Antipsychotic polypharmacy and high-dose prescription in schizophrenia : a 5-year comparison", Aust N Z J Psychiatry, 48, pp.52~60 (2014)
- Aly El-Gabry DM, "Antipsychotic polypharmacy and its relation to metabolic syndrome in patients with schizophrenia : an Egyptian study", J Clin Psychopharmacol, 38, pp.27~33 (2018)
- Takeuchi H, "Antipsychotic polypharmacy and corrected QT interval : a systematic review", Can J Psychiatry, 60, pp.215~222 (2015)
- Paton C, "Augmentation with a second antipsychotic in patients with schizophrenia who partially respond to clozapine : a meta-analysis", J Clin Psychopharmacol, 27, pp.198~204 (2007)
- Taylor DM, "Augmentation of clozapine with a second antipsychotic-a meta-analysis", Acta Psychiatr Scand, 125, pp.15~24 (2012)
- Wang J, "Sulpiride augmentation for schizophrenia", Cochrane Database Syst Rev, (1), pp.REF0598598~ (2010)
- Munro J, "Amisulpride augmentation of clozapine : an open non-randomized study in patients with schizophrenia partially responsive to clozapine", Acta Psychiatr Scand, 110, pp.292~298 (2004)
- Assion HJ, "Amisulpride augmentation in patients with schizophrenia partially responsive or unresponsive to clozapine. A randomized, double-blind, placebo-controlled trial", Pharmacopsychiatry, 41, pp.24~28 (2008)
- Kapur S, "Relationship between dopamine D2 occupancy, clinical response, and side effects : a double-blind PET study of first-episode schizophrenia", Am J Psychiatry, 157, pp.514~520 (2000)
- Nordström AL, "Central D2-dopamine receptor occupancy in relation to antipsychotic drug effects : a double-blind PET study of schizophrenic patients", Biol Psychiatry, 33, pp.227~235 (1993)
- Sakurai H, "Dopamine D2 receptor occupancy and cognition in schizophrenia : analysis of the CATIE data", Schizophr Bull, 39, pp.564~574 (2013)
- Elie D, "Cognitive effects of antipsychotic dosage and polypharmacy : a study with the BACS in patients with schizophrenia and schizoaffective disorder", J Psychopharmacol, 24, pp.1037~1044 (2010)
- Hori H, "Several prescription patterns of antipsychotic drugs influence cognitive functions in Japanese chronic schizophrenia patients", Int J Psychiatry Clin Pract, 16, pp.138~142 (2012)
- Barbui C, "Antipsychotic dose mediates the association between polypharmacy and corrected QT interval", PLoS One, 11, pp.e0148212~ (2016)
- Torniainen M, "Antipsychotic treatment and mortality in schizophrenia", Schizophr Bull, 41, pp.656~663 (2015)
- Tiihonen J, "Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia : an observational follow-up study", Am J Psychiatry, 173, pp.600~606 (2016)
- Santone G, "Patient characteristics and process factors associated with antipsychotic polypharmacy in a nationwide sample of psychiatric inpatients in Italy", Pharmacoepidemiol Drug Saf, 20, pp.441~449 (2011)
- Czobor P, "Treatment adherence in schizophrenia : a patient-level meta-analysis of combined CATIE and EUFEST studies", Eur Neuropsychopharmacol, 25, pp.1158~1166 (2015)
- Misdrahi D, "Determination of adherence profiles in schizophrenia using self-reported adherence : results from the FACE-SZ dataset", J Clin Psychiatry, 77, pp.e1130~ (2016)
- Kim J, "Insight and medication adherence in schizophrenia : an analysis of the CATIE trial", Neuropharmacology, 168, pp.107634~ (2020)
- Mohamed S, "Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia", Schizophr Bull, 35, pp.336~346 (2009)
- Tsutsumi C, "The evolution of antipsychotic switch and polypharmacy in natural practice--a longitudinal perspective", Schizophr Res, 130, pp.40~46 (2011)
- Andreasen NC, "Remission in schizophrenia : proposed criteria and rationale for consensus", Am J Psychiatry, 162, pp.441~449 (2005)
- Lambert M, "Remission in schizophrenia : validity, frequency, predictors, and patients’ perspective 5 years later", Dialogues Clin Neurosci, 12, pp.393~407 (2010)
- Bobes J, "Recovery from schizophrenia : results from a 1-year follow-up observational study of patients in symptomatic remission", Schizophr Res, 115, pp.58~66 (2009)
- San L, "Symptomatic remission and social", vocational functioning in outpatients with schizophrenia : prevalence and associations in a crosssectional study, 2007, pp.22, 490~498
- Wunderink L, "Clinical recovery in first-episode psychosis", Schizophr Bull, 35, pp.362~369 (2009)
- Lambert M, "Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia", J Clin Psychiatry, 67, pp.1690~1697 (2006)
- Novick D, "Symptomatic remission in previously untreated patients with schizophrenia: 2-year results from the SOHO study", Psychopharmacology(Berl), 191, pp.1015~1022 (2007)
- Grech P, "Long-term antipsychotic polypharmacy:how does it start, why does it continue?", Ther Adv Psychopharmacol, 2, pp.5~11 (2012)
- Kadra G, "Long-term antipsychotic polypharmacy prescribing in secondary mental health care and the risk of mortality", Acta Psychiatr Scand, 138, pp.123~132 (2018)
- Wunderink L, "Personalizing antipsychotic treatment : evidence and thoughts on individualized tailoring of antipsychotic dosage in the treatment of psychotic disorders", Ther Adv Psychopharmacol, 9, pp.2045125319836566~ (2019)
- Tani H, "Interventions to reduce antipsychotic polypharmacy : a systematic review", Schizophr Res, 143, pp.215~220 (2013)
- Essock SM, "Effectiveness of switching from antipsychotic polypharmacy to monotherapy", Am J Psychiatry, 168, pp.702~708 (2011)
- Borlido C, "Switching from 2 antipsychotics to 1antipsychotic in schizophrenia : a randomized, double-blind, placebo-controlled study", J Clin Psychiatry, 77, pp.e14~ (2016)
- Constantine RJ, "The risks and benefits of switching patients with schizophrenia or schizoaffective disorder from two to one antipsychotic medication : a randomized controlled trial", Schizophr Res, 166, pp.194~200 (2015)
- Constantine RJ, "Is the risk of antipsychotic polypharmacy discontinuation dependent on the agents used?", Psychiatry Res, 263, pp.238~244 (2018)
- Tani H, "Factors associated with successful antipsychotic dose re-duction in schizophrenia : a systematic review of prospective clinical trials and meta-analysis of randomized controlled trials", Neuropsychopharmacology, 45, pp.887~901 (2020)
- Correll CU, "Antipsychotic polypharmacy : a survey study of prescriber attitudes, knowledge and behavior", Schizophr Res, 131, pp.58~62 (2011)
- James BO, "Attitudes towards and rationale for antipsychotic polypharmacy among psychiatrists in Nigeria : characteristics associated with high reported antipsychotic polypharmacy", Psychiatry Res, 248, pp.134~139 (2017)
- Young SL, "“First do no harm.” A systematic review of the prevalence and management of antipsychotic adverse effects", J Psychopharmacol, 29, pp.353~362 (2015)
- Zink M, "Efficacy and tolerability of ziprasidone versus risperidone as augmentation in patients partially responsive to clozapine : a randomised controlled clinical trial", J Psychopharmacol, 23, pp.305~314 (2009)
- 배치운, "Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?", 전남의대학술지, 56(3), pp.157~165 (2020), 의과학연구소[DOI]