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Rafaniello C, Pozzi M, Pisano S, Ferrajolo C, Bertella S, Sportiello L, Carnovale C, Sullo MG, Cattaneo D, Gentili M, Rizzo R, Pascotto A, Mani E, Villa L, Riccio MP, Sperandeo S, Bernardini R, Bravaccio C, Clementi E, Molteni M, Rossi F, Radice S, Capuano A. Second generation antipsychotics in 'real-life' paediatric patients. Adverse drug reactions and clinical outcomes of drug switch. Expert Opin Drug Saf 2017; 15:1-8. [PMID: 27875914 DOI: 10.1080/14740338.2016.1229301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Gap in knowledge on benefit/risk ratio of second generation antipsychotics (SGA) in the paediatric population represents a challenge for the scientific community. This study aims to analyse all suspected adverse drug reactions (ADRs) to SGA observed during the study period; compare the safety profiles of risperidone and aripiprazole; evaluate the effect of switching from risperidone to aripiprazole or to a first generation antipsychotic (FGA). METHODS Prospective analysis of spontaneously reported ADRs concerning 184 paediatric outpatients between 2012 and 2014.; clinical outcomes of drug switch were evaluated. RESULTS Out of the 184 patients, 130 experienced at least one ADR; ADRs were usually not serious and more frequently associated with aripiprazole. Switching to aripiprazole was associated with better results than switching to FGAs in the Clinical Global Impression scale- Efficacy (CGI-E) scores (p = 0.018), Disturbed behaviour checklist-parents (DBC-P) self-absorption subscale (p = 0.010); only a trend for difference between changing to aripiprazole vs FGAs in the DBC-P total score (p = 0.054) and social relating subscale (p = 0.053) was observed. CONCLUSIONS SGAs safety data were consistent with the ones already known; however, there is still a need to improve the knowledge in pharmacovigilance field among clinicians. Switching to aripiprazole may be a valid alternative to risperidone.
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Affiliation(s)
- Concetta Rafaniello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Marco Pozzi
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Simone Pisano
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Carmen Ferrajolo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Silvana Bertella
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Liberata Sportiello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Carla Carnovale
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Maria Giuseppa Sullo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Dario Cattaneo
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Marta Gentili
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Renata Rizzo
- e Child and Adolescent Neuropsychiatry, Department of Medical and Paediatric Sciences, School of Medicine , University of Catania , Catania , Italy
| | - Antonio Pascotto
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Elisa Mani
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Laura Villa
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Maria Pia Riccio
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Serena Sperandeo
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Renato Bernardini
- f Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine , University of Catania , Catania , Italy
| | - Carmela Bravaccio
- g Department of Translational Medical Sciences , University Federico II of Naples , Naples , Italy
| | - Emilio Clementi
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy.,d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Massimo Molteni
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Francesco Rossi
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Sonia Radice
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Annalisa Capuano
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
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Pozzi M, Pisano S, Bertella S, Capuano A, Rizzo R, Antoniazzi S, Auricchio F, Carnovale C, Cattaneo D, Ferrajolo C, Gentili M, Guastella G, Mani E, Rafaniello C, Riccio MP, Scuderi MG, Sperandeo S, Sportiello L, Villa L, Radice S, Clementi E, Rossi F, Pascotto A, Bernardini R, Molteni M, Bravaccio C. Persistence in Therapy With Risperidone and Aripiprazole in Pediatric Outpatients: A 2-Year Naturalistic Comparison. J Clin Psychiatry 2016; 77:e1601-e1609. [PMID: 27780333 DOI: 10.4088/jcp.15m10247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/18/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The practical effectiveness of second-generation antipsychotics in children and adolescents is an understudied issue. It is a crucial area of study, though, because such patients are often treated for long-lasting disorders. METHODS We carried out a 24-month (March 2012-March 2014) observational study on an unselected population of pediatric outpatients treated with risperidone, aripiprazole, olanzapine, or quetiapine aiming to (1) describe drug use, (2) compare post hoc the discontinuation rates due to specific causes and dose adjustments by Kaplan-Meier analyses between drugs, and (3) analyze predictors influencing these outcomes by Cox multivariate models. RESULTS Among 184 pediatric patients, 77% patients were prescribed risperidone, and 18% were prescribed aripiprazole. Olanzapine or quetiapine were scantly used; therefore, they were excluded from analyses. Risperidone was prevalent in younger, male patients with disruptive behavioral disorders; aripiprazole, in patients with tic disorders. Overall, discontinuations occurred mostly in the first 6 months, and, at 24 months, the discontinuation numbers were similar between users of risperidone and aripiprazole (41.5% vs 39.4%). In univariate analyses, dose reduction was higher for aripiprazole (P = .033). Multivariate analyses yielded the following predictors: for all-cause discontinuation, baseline severity (hazard ratio [HR] = 1.48, P = .001) and dose increase (HR = 3.55, P = .001); for patient-decided discontinuation, dose change (increase: HR = 6.43, P = .004; reduction: HR = 7.89, P = .049) and the presence of concomitant drugs (HR = 4.03, P = .034), while autistic patients discontinued less (HR = 0.23, P = .050); for clinician-decided discontinuation due to adverse drug reactions, baseline severity (HR = 1.96, P = .005) and dose increase (HR = 5.09, P = .016); for clinician-decided discontinuation due to inefficacy, baseline severity (HR = 2.88, P = .014) and the use of aripiprazole (HR = 5.55, P = .013); for dose increase, none; for dose reduction, the occurrence of adverse drug reactions (HR = 4.74, P = .046), while dose reduction was less probable in autistic patients (HR = 0.22, P = .042). CONCLUSIONS The findings of this study show a similarity between the overall effectiveness of risperidone and aripiprazole in a real-life pediatric outpatient setting.
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Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Silvana Bertella
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Renata Rizzo
- Child and Adolescent Neuropsychiatry, Department of Medical and Pediatric Sciences, School of Medicine, University of Catania, Italy
| | - Stefania Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Fabiana Auricchio
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Carmen Ferrajolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Giuseppe Guastella
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Italy
| | - Elisa Mani
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Maria Pia Riccio
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Maria Grazia Scuderi
- Child and Adolescent Neuropsychiatry, Department of Medical and Pediatric Sciences, School of Medicine, University of Catania, Italy
| | - Serena Sperandeo
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Laura Villa
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Via GB Grassi 74, 20157 Milan, Italy. .,Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.,Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Antonio Pascotto
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Renato Bernardini
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Italy
| | - Massimo Molteni
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences, University Federico II of Naples, Italy
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