NYMC Faculty Publications

Switching to Iloperidone: An Omnibus of Clinically Relevant Observations From a 12-Week, Open-Label, Randomized Clinical Trial in 500 Persons With Schizophrenia

Author Type(s)

Faculty

DOI

10.3371/CSRP.CIWE.103114

Journal Title

Clinical Schizophrenia & Related Psychoses

First Page

183

Last Page

195

Document Type

Article

Publication Date

1-1-2015

Department

Psychiatry and Behavioral Sciences

Keywords

Adult, Antipsychotic Agents, Aripiprazole, Benzodiazepines, Dizziness, Female, Humans, Isoxazoles, Male, Olanzapine, Piperazines, Piperidines, Quinolones, Risperidone, Schizophrenia, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVE: To describe secondary analyses from a 12-week, randomized, open-label trial where adult schizophrenia outpatients receiving risperidone, olanzapine, or aripiprazole were switched to iloperidone.

METHODS: Patients were randomized into two groups: one where the antecedent antipsychotic dose was titrated downwards to zero over 2 weeks (n=240), and the other group where the antecedent antipsychotic was abruptly stopped (n=260). Adaptations of the Clinical Global Impression scale were used to evaluate clinical changes. Other assessments included the reporting of adverse events (AEs), study discontinuation, body weight, and metabolic variables.

RESULTS: Improvement was steady throughout the study for both gradual- and immediate-switch groups starting at Week 1 and continuing through Week 12. Discontinuations due to AEs in the first 2 weeks of treatment were higher for the immediate-switch group compared with the gradual-switch group (10.8% vs. 5.4%, NNT 19, 95% CI 10-151). Fewer patients in the gradual-switch group experienced dizziness as an AE, whereas a higher percentage of patients in the immediate-switch group exhibited earlier onset of a therapeutic response within the first 2 weeks; both groups were comparable thereafter with low rates of dizziness and similar efficacy outcomes.

CONCLUSIONS: Switching to iloperidone can be accomplished either with a gradual crossover or immediate discontinuation of the prior antipsychotic; however, the immediate-switch method is associated with greater proportion of initial dizziness. The observed outcomes are consistent with what has been previously reported regarding iloperidone's favorable akathisia/EPS profile and modest impact on somnolence/sedation, body weight, and metabolic variables.

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