Clinical consequences of switching from olanzapine to risperidone and vice versa in outpatients with schizophrenia: 36-month results from the worldwide schizophrenia outpatients health outcomes (W-SOHO) study

BMC Psychiatry

Research Article

Jamie Karagianis¹  Martin Dossenbach²  Diego Novick³  Roberto Brugnoli⁴  Josep Maria Haro⁵  Jihyung Hong⁶ 

[1] Eli Lilly Canada Inc, Toronto, Ontario, Canada;Eli Lilly Ges.m.b.H, Wien, Austria;European Health Outcomes Research, Eli Lilly and Company, Windlesham, Surrey, UK;Fondazione Italiana per lo studio della Schizophrenia, Rome, Italy;Parc Sanitari Sant Joan de Deu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain;Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK;European Health Outcomes Research, Eli Lilly and Company, Windlesham, Surrey, UK;

关键词: Antipsychotic;    Schizophrenia;    Switching;    Olanzapine;    Risperidone;   

DOI  :  10.1186/1471-244X-12-218

 received in 2011-11-04, accepted in 2012-11-28,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundWith many atypical antipsychotics now available in the market, it has become a common clinical practice to switch between atypical agents as a means of achieving the best clinical outcomes. This study aimed to examine the impact of switching from olanzapine to risperidone and vice versa on clinical status and tolerability outcomes in outpatients with schizophrenia in a naturalistic setting.MethodsW-SOHO was a 3-year observational study that involved over 17,000 outpatients with schizophrenia from 37 countries worldwide. The present post hoc study focused on the subgroup of patients who started taking olanzapine at baseline and subsequently made the first switch to risperidone (n=162) and vice versa (n=136). Clinical status was assessed at the visit when the first switch was made (i.e. before switching) and after switching. Logistic regression models examined the impact of medication switch on tolerability outcomes, and linear regression models assessed the association between medication switch and change in the Clinical Global Impression-Schizophrenia (CGI-SCH) overall score or change in weight. In addition, Kaplan-Meier survival curves and Cox-proportional hazards models were used to analyze the time to medication switch as well as time to relapse (symptom worsening as assessed by the CGI-SCH scale or hospitalization).Results48% and 39% of patients switching to olanzapine and risperidone, respectively, remained on the medication without further switches (p=0.019). Patients switching to olanzapine were significantly less likely to experience relapse (hazard ratio: 3.43, 95% CI: 1.43, 8.26), extrapyramidal symptoms (odds ratio [OR]: 4.02, 95% CI: 1.49, 10.89) and amenorrhea/galactorrhea (OR: 8.99, 95% CI: 2.30, 35.13). No significant difference in weight change was, however, found between the two groups. While the CGI-SCH overall score improved in both groups after switching, there was a significantly greater change in those who switched to olanzapine (difference of 0.29 points, p=0.013).ConclusionOur study showed that patients who switched from risperidone to olanzapine were likely to experience a more favorable treatment course than those who switched from olanzapine to risperidone. Given the nature of observational study design and small sample size, additional studies are warranted.

【 授权许可】

CC BY   
© Hong et al.; licensee BioMed Central Ltd. 2012