NYMC Faculty Publications

Effectiveness of Lurasidone in Patients With Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics: A Randomized, 6-Week, Open-Label Study

Author Type(s)

Faculty

DOI

10.4088/JCP.12m07992

Journal Title

The Journal of Clinical Psychiatry

First Page

170

Last Page

179

Document Type

Article

Publication Date

2-1-2013

Department

Psychiatry and Behavioral Sciences

Keywords

Adult, Akathisia, Drug-Induced, Antipsychotic Agents, Benzodiazepines, Dibenzothiazepines, Drug Administration Schedule, Female, Humans, Isoindoles, Lurasidone Hydrochloride, Male, Olanzapine, Psychotic Disorders, Quetiapine Fumarate, Schizophrenia, Thiazoles, Time Factors, Treatment Failure, Treatment Outcome

Disciplines

Medical Pharmacology | Medicine and Health Sciences | Psychiatry

Abstract

OBJECTIVE: To examine the effectiveness of switching patients to lurasidone using 3 different dosing strategies.

METHOD: Adults with DSM-IV-defined schizophrenia or schizoaffective disorder in a nonacute phase of illness were randomized to 1 of 3 lurasidone dosing regimens for the initial 2 weeks of the study: (1) 40 mg/d for 2 weeks; (2) 40 mg/d for 1 week, increased to 80 mg/d on day 8 for week 2 (up-titration group); and (3) 80 mg/d for 2 weeks. Lurasidone was then flexibly dosed (40-120 mg/d) for the subsequent 4 weeks of the study. The preswitch antipsychotic agent was tapered by day 7 to 50% of the original dose and discontinued by the end of week 2. Subjects were stratified on the basis of whether the primary preswitch antipsychotic medication was classified as "sedating" (olanzapine or quetiapine) or "nonsedating" (all other antipsychotics). The primary outcome measure was time to treatment failure, defined as any occurrence of insufficient clinical response, exacerbation of underlying disease, or discontinuation due to an adverse event. The study was conducted from June 2010 to May 2011.

RESULTS: Of 240 subjects treated in this study, 86 (35.8%) were treated with an antecedent sedating antipsychotic, and 154 (64.2%) were treated with an antecedent nonsedating antipsychotic. Nineteen (7.9%) of the 240 patients experienced treatment failure. No clinically relevant differences were observed when the 3 randomized switch groups were compared. Treatment failure rates were 10/86 (11.6%) versus 9/154 (5.8%) among subjects who had been receiving a preswitch sedating versus nonsedating antipsychotic medication, respectively. Consistent with prior studies of lurasidone, there was no signal for clinically relevant adverse changes in body weight, glucose, insulin, lipids, or prolactin; mean improvements in weight and lipids were observed. Movement disorder rating scales did not demonstrate meaningful changes. The incidence of akathisia as an adverse event was 12.5%; only 1 subject (0.4%) discontinued due to akathisia.

CONCLUSIONS: Switching patients to lurasidone can be successfully accomplished by starting at 40 mg/d for 2 weeks, or 80 mg/d for 2 weeks, or 40 mg/d for 1 week followed by 80 mg/d the second week.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01143077.

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