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Benarous X, Cottin G, Lahaye H, de la Rivière SG, Guilé JM, Speranza M, Bonnot O, Cohen D. Efficacy, Tolerability, and Acceptance of Long-Lasting Antipsychotics in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2022; 32:312-327. [PMID: 35613381 DOI: 10.1089/cap.2021.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: While long-lasting antipsychotics (LLA) were specifically developed to address the problem of adherence in patients with chronic psychiatric disorders, their role in pediatric populations is not clear. Methods: To document the efficacy, tolerance, and acceptance of LLAs in children and adolescents, a literature search was conducted using several databases for published studies (PubMed, PsycINFO) from January 1965 to December 2020. Twenty-two studies were identified (16 case reports/series, 3 open label studies, 2 controlled studies, and 1 retrospective analysis of national database). Results: Demographic features were widely heterogeneous across studies (total N = 480, 58% male, mean age = 15.0 ± 1.8). Case reports/series presented positive therapeutic outcomes in noncompliant youths with severe mental illness. Three open-label one-arm studies supported the clinical efficacy of risperidone long-acting injection in patients previously stabilized with oral risperidone. One study showed lower clinical symptoms and higher functioning at 12 months in youths treated for an acute psychotic episode with paliperidone palmitate compared to oral risperidone. The types and rates of side effects of LLA were comparable to those observed for oral antipsychotics. Two studies suggested better metabolic and neurological tolerance of LLA compared to an oral form. Preliminary evidence supported a satisfactory level of treatment satisfaction in patients treated with LLA and their families, while concerns were raised regarding practical administration in outpatient services. However, the average quality of the evidence based on the RoB2 tool was low. Conclusions: The level of evidence was low for the efficacy of LLA in pediatric populations and very low for the tolerance and acceptance. It concerned mostly the effect of risperidone long-acting injection in adolescents with psychotic disorders. Randomized maintenance clinical trials using noninferiority analysis would be more appropriate for further research.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Guillaume Cottin
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Hélène Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Sébastien Garny de la Rivière
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - Jean-Marc Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France.,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Versailles University Hospital, Versailles, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Nantes University Hospital, Nantes, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France.,CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne University, Paris, France
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Fortea A, Ilzarbe D, Espinosa L, Solerdelcoll M, de Castro C, Oriolo G, Sugranyes G, Baeza I. Long-Acting Injectable Atypical Antipsychotic Use in Adolescents: An Observational Study. J Child Adolesc Psychopharmacol 2018; 28:252-257. [PMID: 29381388 DOI: 10.1089/cap.2017.0096] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Although second generation long-acting injectable antipsychotics (SG-LAIAs) have been approved and are widely used in adults, there is limited evidence for the use of long-acting formulations in children and adolescents. Thus, we systematically describe the off-label use of SG-LAIAs in clinical practice in adolescent inpatients. METHODS All individuals admitted to our Children and Adolescent Inpatient Psychiatry Unit receiving treatment with SG-LAIAs between January 2013 and June 2016 were reviewed. A retrospective analysis of medical records was conducted. Clinical diagnoses were established using DSM-5 criteria. RESULTS Thirty individuals (53.3% female) out of a total of 1,148 admitted patients (2.6%) were identified. The mean age was 16.3 (SD = 1.3; range: 12.5-17.9).The main diagnoses were psychosis (70%) and disruptive behavior disorders (DBDs) (30%), although comorbidity was frequent (96.6%), especially drug use (55.2%, mostly cannabis). SG-LAIAs used were aripiprazole (40%), risperidone (36.7%), and paliperidone palmitate (23.3%), and the main reasons were a history of low compliance (90%) and/or poor insight (73.3%). A mean improvement of 31.7 (SD = 8.7) between admission and discharge was registered in the Children's Global Assessment Scale (CGAS); no differences were observed between different SG-LAIAs. Although they were generally well tolerated, 23.3% of patients reported mild short-term side effects, which were more frequent with risperidone than with aripiprazole (p = .014). CONCLUSIONS Our clinical experience suggests that SG-LAIAs may be a safe treatment option during adolescence in inpatients with psychotic disorders, as well as with DBD. No differences were found in CGAS improvement scores between the three SGA-LAIAs used, although patients on risperidone reported more side effects than those on aripiprazole. Further research is needed so as to evaluate safety and effectiveness of SG-LAIAs in this population.
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Affiliation(s)
- Adriana Fortea
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Daniel Ilzarbe
- 2 Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College of London , London, United Kingdom
| | - Laura Espinosa
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Mireia Solerdelcoll
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Clara de Castro
- 3 Centro de Salud Mental Infanto-Juvenil, Hospital Sant Joan de Déu , Cornellá de Llobregat, Barcelona, Spain
| | - Giovanni Oriolo
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Gisela Sugranyes
- 4 Department of Child and Adolescent Psychiatry, Institute of Neuroscience, Hospital Clínic de Barcelona , Barcelona, Spain .,5 Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (CERCA-IDIBAPS) , Barcelona, Spain .,6 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Barcelona, Spain
| | - Inmaculada Baeza
- 4 Department of Child and Adolescent Psychiatry, Institute of Neuroscience, Hospital Clínic de Barcelona , Barcelona, Spain .,5 Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (CERCA-IDIBAPS) , Barcelona, Spain .,6 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Barcelona, Spain
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