NYMC Faculty Publications

A Trial Evaluating Gradual- or Immediate-Switch Strategies from Risperidone, Olanzapine, or Aripiprazole to Iloperidone in Patients with Schizophrenia

Author Type(s)

Faculty

DOI

10.1016/j.schres.2013.11.042

Journal Title

Schizophrenia Research

First Page

160

Last Page

168

Document Type

Article

Publication Date

3-1-2014

Department

Psychiatry and Behavioral Sciences

Keywords

Adolescent, Adult, Analysis of Variance, Antipsychotic Agents, Aortic Bodies, Aripiprazole, Benzodiazepines, Cohort Studies, Drug Administration Schedule, Drug Substitution, Female, Humans, Isoxazoles, Male, Middle Aged, Olanzapine, Piperazines, Piperidines, Psychiatric Status Rating Scales, Quinolones, Risperidone, Schizophrenia, Surveys and Questionnaires, Treatment Outcome, Young Adult

Disciplines

Medicine and Health Sciences

Abstract

In a 12-week randomized open-label trial, adults diagnosed with schizophrenia experiencing inadequate efficacy and/or poor tolerability on risperidone, olanzapine, or aripiprazole were randomized to switch to iloperidone either gradually (ie, down-titration of current therapy over the first 2weeks [to 50% on Day 1, 25% by Week 1, 0% by Week 2]) or immediately. All patients were titrated on iloperidone to 6mg BID by Day 4, then flexibly dosing between 6 and 12mg BID, as needed. The primary variable was the Integrated Clinical Global Impression of Change (I-CGI-C) and the primary analysis time point was Week 12. A total of 500 patients were randomized and received iloperidone (gradual switch, 240; immediate switch, 260), with 175, 155, and 170 patients switched from risperidone, olanzapine, and aripiprazole, respectively. I-CGI-C Results confirmed improved outcomes at Week 12, with scores that were similar between the gradual- and immediate-switch groups, respectively, for risperidone, 2.82 and 2.67 (95% CI: -0.229, 0.511); olanzapine, 2.87 and 3.03 (95% CI: -0.548, 0.235); and aripiprazole, 2.79 and 2.81 (95% CI: -0.405, 0.368). Incidence of adverse events (AEs) was similar in both switch groups, with the most frequently reported (≥10%) being dizziness, dry mouth, somnolence, and weight increase. In conclusion, switching to iloperidone by either a gradual or an immediate method did not reveal any clinically significant differences in ratings of overall efficacy and safety/tolerability outcomes, based on the I-CGI-C at 12weeks. Similar overall safety/AE profiles were observed regardless of the specific agent from which patients were switched.

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