Early Non-Response as a Predictor of Later Non-Response to Antipsychotics in Schizophrenia: A Randomized Trial

Authors

Yujun Long
Qiongqiong Wu
Ye Yang
Jingda Cai
Jingmei Xiao
Zhaoqian Liu
Yifeng Xu
Ying Chen
Manli Huang
Ruiguo Zhang
Xijia Xu
Jian Hu
Zhifen Liu
Fang Liu
Yingjun Zheng
Huaqing Meng
Zhimin Wang
Yanqing Tang
Xueqin Song
Yunchun Chen
Xueyi Wang
Tiebang Liu
Xiaoli Wu
Maosheng Fang
Chunling Wan
Jingping Zhao
Renrong Wu

Publication Date

7-19-2023

Journal

BMC Medicine

Abstract

BACKGROUND: It remains a challenge to predict the long-term response to antipsychotics in patients with schizophrenia who do not respond at an early stage. This study aimed to investigate the optimal predictive cut-off value for early non-response that would better predict later non-response to antipsychotics in patients with schizophrenia.

METHODS: This multicenter, 8-week, open-label, randomized trial was conducted at 19 psychiatric centers throughout China. All enrolled participants were assigned to olanzapine, risperidone, amisulpride, or aripiprazole monotherapy for 8 weeks. The positive and negative syndrome scale (PANSS) was evaluated at baseline, week 2, week 4, and week 8. The main outcome was the prediction of nonresponse. Nonresponse is defined as a < 20% reduction in the total scores of PANSS from baseline to endpoint. Severity ratings of mild, moderate, and severe illness corresponded to baseline PANSS total scores of 58, 75, and 95, respectively.

RESULTS: At week 2, a reduction of < 5% in the PANSS total score showed the highest total accuracy in the severe and mild schizophrenia patients (total accuracy, 75.0% and 80.8%, respectively), and patients who were treated with the risperidone and amisulpride groups (total accuracy, 82.4%, and 78.2%, respectively). A 10% decrease exhibited the best overall accuracy in the moderate schizophrenia patients (total accuracy, 84.0%), olanzapine (total accuracy, 79.2%), and aripiprazole group (total accuracy, 77.4%). At week 4, the best predictive cut-off value was < 20%, regardless of the antipsychotic or severity of illness (total accuracy ranging from 89.8 to 92.1%).

CONCLUSIONS: Symptom reduction at week 2 has acceptable discrimination in predicting later non-response to antipsychotics in schizophrenia, and a more accurate predictive cut-off value should be determined according to the medication regimen and baseline illness severity. The response to treatment during the next 2 weeks after week 2 could be further assessed to determine whether there is a need to change antipsychotic medication during the first four weeks.

TRIAL REGISTRATION: This study was registered on Clinicaltrials.gov (NCT03451734).

Keywords

Humans, Antipsychotic Agents, Schizophrenia, Olanzapine, Risperidone, Aripiprazole, Amisulpride, Treatment Outcome, Schizophrenia, Early response, Atypical antipsychotic, Prediction

Comments

Supplementary Materials

PMID: 37468932