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Correll CU, Brieden A, Janetzky W. Symptomatic, functional and quality of life measures of remission in 194 outpatients with schizophrenia followed naturalistically in a 6-month, non-interventional study of aripiprazole once-monthly. Schizophrenia (Heidelb) 2023; 9:80. [PMID: 37935711 PMCID: PMC10630463 DOI: 10.1038/s41537-023-00405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
An important goal in the treatment of patients with schizophrenia is remission in various domains, i.e., of symptoms, psychosocial functioning and subjective well-being. We undertook a post hoc analysis of pre-stabilized outpatients with schizophrenia and complete outcome data who had been enrolled in a 6-month non-interventional study of aripiprazole once-monthly (AOM) at 75 German sites. Key outcomes were (i) symptomatic remission (cross-sectional Andreasen et al. criteria (≤mild positive and negative key symptoms on the Brief Psychiatric Rating Scale (BPRS))); (ii) functional remission (Global Assessment of Functioning (GAF) scale score >70), and (iii) subjective well-being remission (WHO-5 scale score ≥13) at week 24. Of 242 enrolled patients, 194 (80.2%) (age = 43.9 ± 15.3 years; 51.5% male, illness duration = 14.0 ± 12.0 years) with complete data were analyzed. While 61.3% of the patients achieved symptomatic remission and 76.8% achieved remission regarding subjective well-being, only 24.7% achieved psychosocial functioning remission at 6 months. Remission rates were similar for men and women and across strata of disease duration with, on average, less remission in patients with longer illness duration. Correlations of improvements on the BPRS and GAF were weak, with the weakest correlation between the BPRS depressive mood item and the GAF scale, but similarly high correlation between BPRS subscales or the BPRS depressive mood item and subjective well-being. These findings suggest that while treatment with AOM can lead to symptomatic remission and remission regarding subjective well-being, additional interventions such as psychosocial therapy or supported employment and education may be necessary to achieve functional remission.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| | - Andreas Brieden
- Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany
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Schöttle D, Wiedemann K, Correll CU, Janetzky W, Friede M, Jahn H, Brieden A. Response prediction in treatment of patients with schizophrenia after switching from oral aripiprazole to aripiprazole once-monthly. Schizophr Res 2023; 260:183-190. [PMID: 37683508 DOI: 10.1016/j.schres.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/12/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | - Holger Jahn
- AMEOS Kliniken Heiligenhafen, AMEOS Krankenhausgesellschaft Holstein mbH, Oldenburg i. H., Preetz, Kiel, Germany.
| | - Andreas Brieden
- Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577 Neubiberg, Germany.
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Oluboka O, Clerzius G, Janetzky W, Schöttle D, Therrien F, Wiedemann K, Roy MA. Improvement of functioning in patients with schizophrenia: real-world effectiveness of aripiprazole once-monthly (REACT study). BMC Psychiatry 2023; 23:383. [PMID: 37259053 DOI: 10.1186/s12888-023-04893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Functional impairment affects many patients with schizophrenia. Treatment with the long-acting injectable antipsychotic aripiprazole once-monthly (AOM) may help improve functioning. OBJECTIVES To explore changes in functioning in patients with schizophrenia who received AOM treatment in observational studies. METHODS Here we report functional outcomes in the form of Global Assessment of Functioning (GAF) scores in a pooled analysis of data from two observational studies from Canada (NCT02131415) and Germany (vfa non-interventional studies registry 15960N). Data from 396 patients were analyzed. RESULTS At baseline, the mean GAF score was 47.7 (SD 13.4). During 6 months of treatment with AOM, the mean GAF score increased to 59.4 (SD 15.8). Subgroups stratified by patient age (≤35 years/>35 years), sex, disease duration (≤5 years/>5 years) and disease severity at baseline had all significantly improved their GAF at month 6. 51.5% of the patients showed a GAF score increase of at least 10 points, which was regarded as clinically meaningful, and were considered responders. CONCLUSIONS These data show that treatment with AOM may help improve patient functioning in a routine treatment setting. TRIAL REGISTRATION NCT02131415 (May 6, 2014), vfa non-interventional studies registry 15960N.
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Affiliation(s)
- Oloruntoba Oluboka
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Guerline Clerzius
- Lundbeck Canada Inc, 2600 Alfred-Nobel Boulevard, Saint-Laurent, QC, H4S 0A9, Canada
| | | | - Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - François Therrien
- Otsuka Canada Pharmaceutical Inc., 2250 Alfred-Nobel Boulevard, Saint-Laurent, QC, H4S 2C9, Canada
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Faculté de Médecine, Centre de recherche CERVO, Université Laval, Clinique Notre-Dame des Victoires, 2525, chemin de la Canardière Porte, A-1-2, Québec, G1J 2G3, Canada
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Schöttle D, Janetzky W, Therrien F, Wiedemann K. BPRS domains, items and subgroups analyses, and CGI-I ratings in pooled data from non-interventional studies of aripiprazole once-monthly in schizophrenia (REACT study). BMC Psychiatry 2023; 23:162. [PMID: 36918846 PMCID: PMC10015766 DOI: 10.1186/s12888-023-04651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Patients with schizophrenia may benefit from treatment with long-acting injectable (LAI) formulations of antipsychotics. Aripiprazole once-monthly (AOM) is an LAI that was tested in two non-interventional studies in Germany and Canada. METHODS Here, we report on analyses of pooled data from the two non-interventional studies. Patients were treated with AOM under real-life conditions. Data were analyzed for a timeframe of 6 months. We analyzed data on Brief Psychiatric Rating Scale (BPRS) domains and items, BPRS total scores in various patient subgroups (male vs. female patients, patients with disease duration ≤ 5 years and > 5 years, patients with different levels of disease severity at baseline), Clinical Global Impression - Improvement (CGI-I) ratings for the total population and subgroups, and comorbidities for the total population. RESULTS Data from 409 patients were included. 65.5% of the patients had comorbidities. Improvements were found in all BPRS domains and items. Furthermore, improvements were similar for male and female patients, patients with disease duration ≤ 5 years and > 5 years, and across different levels of disease severity at baseline. Numerically, more favorable results were found for younger patients, female patients, and those with shorter disease duration. CONCLUSIONS AOM can be an effective treatment in the broad range of patients, across sexes, regardless of patient age and duration of disease, independently of disease severity, and across symptoms. TRIAL REGISTRATION NCT02131415 (May 6, 2014), vfa non-interventional studies registry 15960N.
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Affiliation(s)
- Daniel Schöttle
- Klinik Für Psychiatrie Und Psychotherapie, Zentrum Für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | | | - Francois Therrien
- Otsuka Canada Pharmaceutical Inc., 2250 Alfred-Nobel Boulevard, Saint-Laurent, Québec, H4S 2C9, Canada
| | - Klaus Wiedemann
- Klinik Für Psychiatrie Und Psychotherapie, Zentrum Für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Schöttle D, Clerzius G, Janetzky W, Oluboka T, Roy MA, Therrien F, Wiedemann K. Real-world effectiveness of aripiprazole once-monthly: pooled analysis of two non-interventional studies. Eur Psychiatry 2022; 65:e42. [PMID: 35855645 PMCID: PMC9393913 DOI: 10.1192/j.eurpsy.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Noninterventional naturalistic studies are an important complement to randomized controlled trials. Aripiprazole once-monthly (AOM) is an atypical antipsychotic in a long-acting injectable formulation. Methods A pooled analysis of two noninterventional studies was undertaken to validate previous results on AOM effectiveness and safety in a larger population and improve statistical power for preplanned subgroup analyses. We analyzed data from 409 patients with schizophrenia who were treated with AOM and were enrolled in noninterventional studies in Germany (via noninterventional studies registry 15,960 N) and Canada (NCT02131415). Data collected at baseline, 3 and 6 months were analyzed. Among the endpoints were psychopathology (brief psychiatric rating scale [BPRS]) and disease severity (clinical global impression [CGI]). Results Mean patient age was 38.9 (SD 14.8) years, and 59.9% were male. BPRS decreased from 48.1 (SD 15.6) at baseline to 36.5 (SD 13.7) at month 6 (p < 0.001). CGI decreased from 4.47 (SD 0.90) at baseline to 3.64 (SD 1.16) at month 6 (p < 0.001). A total of 54.4% were responders (at least 20% reduction) on the BPRS, and 56.5% had a CGI-S-score that was at least 1 level better than baseline. A total of 43.4% were considered responders on both the BPRS and CGI scales. A total of 45.2% were considered in remission. Adverse events were rare and corresponded to the previously known safety profile of AOM. Conclusions Treatment with AOM for patients with schizophrenia appeared effective and safe under real-life conditions.
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Affiliation(s)
- Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246Hamburg, Germany
| | - Guerline Clerzius
- Lundbeck Canada Inc., 2600 Alfred-Nobel boulevard, Saint-Laurent, QuébecH4S 0A9, Canada
| | | | - Toba Oluboka
- University of Calgary, 2500 University Drive NW, Calgary AlbertaT2N 1N4, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Pavillon Ferdinand-Vandry, local 4889, Université Laval, Québec G1V 0A6, Canada; Centre de recherche CERVO 2301, avenue D'Estimauville, Québec G1E 1T2, Canada; Clinique Notre-Dame des Victoires, 2525, chemin de la Canardière Porte : A-1-2, QuébecG1J 2G3, Canada, e-mail:
| | - François Therrien
- Otsuka Canada Pharmaceutical Inc., 2250 Alfred-Nobel boulevard, Saint-Laurent, Québec H4S 2C9, Canada, e-mail:
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246Hamburg, Germany
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Leopold K, Becker T, Förstl J, Kiefer F, de Millas W, Janetzky W, Lambert M, Pfennig A, Bechdolf A. [Early Intervention in Schizophrenia - an Update]. Fortschr Neurol Psychiatr 2020; 88:387-397. [PMID: 32557467 DOI: 10.1055/a-0918-6071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In Germany, psychoses are still diagnosed too late. The average duration of untreated psychosis is (DUP) one year. Early intervention should, therefore, be given higher priority. The shorter the duration of the DUP, the higher the probability of permanent recovery and a better long-term prognosis. Public education work and specialised early detection centres with low-threshold access can improve care and thus the prospects of patients, mostly young, and already in the early phase of the disease. In addition to anti-psychotic therapy, evidence-based psychotherapeutic procedures, family and peer work, as well as accompanying offers are necessary to support patients individually in being or remaining reintegrated into the labour market ("Individual Placement and Support", IPS). While in some countries, such as Denmark and Australia, the possibility of early intervention is already part of standard care, Germany has not yet gone beyond model projects. Changing this must be one of the main objectives for the coming years. With this review, the authors would therefore like to encourage further thinking and action.
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Leopold K, Becker T, Förstl H, Kiefer F, de Millas W, Janetzky W, Lambert M, Pfennig A, Bechdolf A. [Early Intervention in Schizophrenia - an Update]. Fortschr Neurol Psychiatr 2020; 88:e1. [PMID: 32785908 DOI: 10.1055/a-1207-6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Reimer J, Kuhn J, Wietfeld R, Janetzky W, Leopold K. [Motivational interviewing : A possibility for doctor-patient communication in schizophrenia?]. Nervenarzt 2019; 90:1144-1153. [PMID: 30941459 DOI: 10.1007/s00115-019-0702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Motivational interviewing (MI) has become established nowadays as an approach for a cooperative style of conversation to promote intrinsic motivation for change by exploring and resolving ambivalences. The change of addictive behavior is no longer sought by exerting pressure or lecturing/converting attempts of convincing or persuasion but by activating existing but "buried" or newly acquired self-motivation to change. The MI is now also used to change the treatment of other health-related behavior and chronic diseases, including schizophrenic disorders. Compared to the efficacy of MI in the addiction area, the data situation in schizophrenic patients is still insufficient. According to the available studies, MI can positively influence important aspects of disease-related impairments, such as medication adherence, the frequency and severity of psychotic relapses, the duration of hospitalization, the level of function, insight into the disease and cognitive rehabilitation. The practical implementation of MI requires a good knowledge of the method as well as changes in treatment principles and work processes.
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Affiliation(s)
- Jens Reimer
- Zentrum für Psychosoziale Medizin Gesundheit Nord, 28102, Bremen, Deutschland. .,Klinikum Bremen-Ost, Züricher Str. 40, 28325, Bremen, Deutschland. .,Zentrum für Interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Universität Hamburg, Hamburg, Deutschland.
| | - Jens Kuhn
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Johanniter Krankenhaus Oberhausen, Evangelischer Klinikverbund Niederrhein gGmbH, Oberhausen, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Köln, Deutschland
| | - Rita Wietfeld
- Psychotherapie, Praxis Neurologie und Psychiatrie, Witten, Deutschland
| | | | - Karolina Leopold
- Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum am Urban, Berlin, Deutschland
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Schöttle D, Janetzky W, Luedecke D, Beck E, Correll CU, Wiedemann K. Correction to: Effectiveness of aripiprazole once-monthly in schizophrenia patients pretreated with oral aripiprazole: a 6-month, real-life non-interventional study. BMC Psychiatry 2018; 18:389. [PMID: 30551736 PMCID: PMC6295094 DOI: 10.1186/s12888-018-1968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 11/25/2022] Open
Abstract
Following publication of the original article.
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Affiliation(s)
- Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale, Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20, ,246, Hamburg, Germany.
| | - Wolfgang Janetzky
- 0000 0004 0390 8559grid.491986.bLundbeck GmbH, Ericusspitze 2, 20, ,457 Hamburg, Germany
| | - Daniel Luedecke
- 0000 0001 2180 3484grid.13648.38Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale, Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20, ,246 Hamburg, Germany
| | - Elmar Beck
- 0000 0004 0554 0153grid.491678.5ANFOMED GmbH, Röttenbacher Str. 17, 91,096, Möhrendorf, Germany
| | - Christoph U. Correll
- grid.440243.5Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 75–59 263rd St, Glen Oaks, NY 11004 USA ,0000 0001 2284 9943grid.257060.6Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY 11549 USA ,0000 0001 2218 4662grid.6363.0Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Augustenburger Platz 1 (Mittelallee 5A), 13, ,353 Berlin, Germany
| | - Klaus Wiedemann
- 0000 0001 2180 3484grid.13648.38Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale, Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20, ,246 Hamburg, Germany
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Bullinger M, Kuhn J, Leopold K, Janetzky W, Wietfeld R. [Quality of life as a target criterion in schizophrenia therapy]. Fortschr Neurol Psychiatr 2018; 87:348-356. [PMID: 30541162 DOI: 10.1055/a-0646-3951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Consideration of quality of life has developed into an important concept of a patient-oriented medicine in the last 50 years. With it, it should be possible to capture the subjective experience of the patients and describe its different dimensions. Today, the quality of life as a patient-reported endpoint is also an integral part of the early benefit assessment under the German Drug Market Reorganization Act. In the treatment of schizophrenic patients, however, improvement in quality of life as an accepted target criterion has only been established with delay.
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Affiliation(s)
- Monika Bullinger
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie
| | - Jens Kuhn
- Johanniter Krankenhaus Oberhausen, Evangelischer Klinikverbund Niederrhein gGmbH, Klinik für Psychiatrie, Psychotherapie und Psychosomatik.,Universitätsklinikum Köln, Klinik und Poliklinik für Psychiatrie und Psychotherapie
| | - Karolina Leopold
- Vivantes Klinikum am Urban, Psychiatrie, Psychotherapie und Psychosomatik
| | | | - Rita Wietfeld
- Praxis Dr. Wietfeld, Fachärztin für Neurologie, Psychiatrie und Psychotherapie
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Schöttle D, Janetzky W, Luedecke D, Beck E, Correll CU, Wiedemann K. Effectiveness of aripiprazole once-monthly in schizophrenia patients pretreated with oral aripiprazole: a 6-month, real-life non-interventional study. BMC Psychiatry 2018; 18:365. [PMID: 30428862 PMCID: PMC6237037 DOI: 10.1186/s12888-018-1946-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In this study, the treatment of schizophrenia patients with aripiprazole once-monthly (AOM) was evaluated under real-life conditions in a naturalistic setting. METHODS This multicenter, prospective, non-interventional study included 242 patients (age = 43.1 ± 15.1 years, 55.0% male) who were monitored during 6 months of AOM treatment. Endpoints included measurements of psychopathology (Brief Psychiatric Rating Scale, BPRS) and severity of illness scales (Clinical Global Impressions-Severity, CGI-S, and -Improvement, CGI-I). Furthermore, treatment-related adverse events (TRAEs) were recorded. RESULTS At baseline, the mean BPRS total score was 54.1 ± 15.6, the mean CGI-S was 4.8 ± 0.8 and the most frequent illness category was 'markedly ill' (41.7%). Patients had been pretreated with oral aripiprazole for a mean duration of 9.7 months (SD: 22.3) and 87.9% were deemed by their clinician as "clinically stable" and for a mean of 5.9 months. The difference in global BPRS after 6 months was - 13.8 (SD: 16.0; 95% CI: [- 15.9; - 11.7]; p < 0.001). The proportion of patients with high CGI-S scores decreased and the proportion of patients with low scores increased significantly (p < 0.001, respectively). BPRS scores improved numerically especially well in younger patients ≤35 years, CGI-S scores decreased significantly more in this population. TRAEs were rare, with low incidences of extrapyramidal symptoms (2.9%) or weight increase (0.4%). CONCLUSIONS Treatment with AOM showed satisfying effectiveness in outpatients with further improvement of psychopathology after oral aripiprazole treatment for a considerable duration and even after having achieved clinically judged "stability". Our findings indicate a robust therapeutic effect of AOM and substantiate previous results from randomized controlled trials under real-world routine conditions.
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Affiliation(s)
- Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | | | - Daniel Luedecke
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Elmar Beck
- ANFOMED GmbH, Röttenbacher Str. 17, 91096 Möhrendorf, Germany
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004 USA
- Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, 500 Hofstra Blvd, Hempstead, NY 11549 USA
- Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1 (Mittelallee 5A), 13353 Berlin, Germany
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Rüther E, Hellweg R, Janetzky W. [Assessment of benefits of drug therapies: memantine for Alzheimer's disease as an example]. Fortschr Neurol Psychiatr 2012; 80:694-699. [PMID: 23229102 DOI: 10.1055/s-0032-1312976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
After the approval of a drug, which represents a first assessment, independent institutions and medical professional associations provide further evaluations. Here, the question is to be asked whether common or diverging evaluation methods exist that can have an impact on the result. In principle, two methods are used: meta-analyses and responder analyses. Meta-analyses and the resulting effect sizes have to be interpreted according to the field of application (for example, the type and severity degree of a disease) with medical expertise. Omitting this can lead to incorrect evaluations and to a discrepancy of evaluation results. In the case of memantine, the merely biometric evaluation of meta-analyses performed by the IQWiG led to a denial of the benefit, while the same data, considering clinical routine, led professional associations to recommend memantine for moderate to severe Alzheimer´s disease. In contrast to meta-analyses, responder analyses directly show the benefit of a therapy option in the presence of significant group differences, as the selected responder criteria are based on the indication. The corresponding results of the responder analyses on memantine were also acknowledged by the IQWiG and led to a positive evaluation of memantine. This discrepancy of evaluation results illustrates the fact that statistical procedures are necessary when evaluating drug and non-drug therapy options but, that the interpretation of the results with medical expertise is essential.
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Affiliation(s)
- E Rüther
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Göttingen
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Förstl H, Stamouli SS, Janetzky W, Galanopoulos A, Karageorgiou C, Tzanakaki M. Memantine in everyday clinical practice: a comparison of studies in Germany and Greece. Dement Geriatr Cogn Disord 2012; 32:267-72. [PMID: 22237255 DOI: 10.1159/000334991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Accepted: 11/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Results from German and Greek non-interventional studies were compared to investigate possible differences concerning efficacy, tolerability and compliance between both countries. METHODS In two open-label, multicentre, non-interventional studies, 4,305 patients with mild to severe Alzheimer's disease (AD) were treated with daily doses of 20 mg memantine for 6 months. Efficacy was assessed using the Mini-Mental State Examination (MMSE) and instrumental activities of daily living (IADL) scales. Safety and tolerability were recorded. RESULTS After 6 months, the patients showed an improvement of their cognitive performance by 2 MMSE points compared to baseline (p < 0.001). MMSE values were improved in 67.4% of the patients, while 15.1% remained stable, and MMSE deteriorated in 17.5% only. The ability to perform IADL increased, as is indicated by lower values (baseline: 70.5; after 6 months: 66.6 points). Improvement of cognition and IADL was nearly identical in both countries. Treatment discontinuation was significantly more frequent in the Greek population, mainly due to non-adherence (9.4% of the safety population). 345 adverse events were recorded in 245 patients (6.3%), and they were significantly associated with country and age. CONCLUSION The results correspond to those of clinical trials and support the efficacy and good tolerability of memantine in a realistic setting. Differences between the countries were observed regarding the baseline characteristics of patients (more female, older and more severe patients in Germany as well as less pretreatment with cholinesterase inhibitors) and regarding premature discontinuation and reported adverse drug reactions, which were both higher in Greece.
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Affiliation(s)
- H Förstl
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Greece. hans.foerstl @ lrz.tum.de
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Hellweg R, Wirth Y, Janetzky W, Hartmann S. Efficacy of memantine in delaying clinical worsening in Alzheimer's disease (AD): responder analyses of nine clinical trials with patients with moderate to severe AD. Int J Geriatr Psychiatry 2012; 27:651-6. [PMID: 22513699 DOI: 10.1002/gps.2766] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [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: 03/29/2011] [Accepted: 06/28/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Responder analyses are of relevance to evaluate the benefits of a medical treatment. The aim of the current paper is to analyse the response of patients with moderate to severe Alzheimer's disease (AD) to memantine, and clinical relevant response is defined as a delay of clinical worsening. METHODS Post hoc analyses were performed over the results of nine individual clinical trials including 2506 study patients. Overall, estimates of the odds ratio (OR) and corresponding confidence intervals were based upon a random-effect model for three individual domains (cognition, activities of daily living and clinical global impression). In addition, a combined responder criterion (triple response) includes all three individual domains. RESULTS Responder analyses have shown that AD patients treated with memantine benefited from a significant delay of clinical worsening compared with placebo-treated patients, and fewer patients faced clinical worsening in the relevant domains cognition (24.6% vs 36.2%, p < 0.001), activities of daily living (56.2% vs 61.6%, p < 0.05) and global impression of change (40.9% vs 49.8, p < 0.001). In addition, response to treatment on the combined domains (triple response) was significantly in favour of memantine compared with placebo, with fewer patients showing clinical worsening (11.0% vs 20.4%, p < 0.001). CONCLUSIONS Treatment with memantine delays clinical worsening in patients with moderate to severe AD when compared with placebo. This effect was seen in single domains (cognition, functional abilities and clinical global impression) as well as in the combination of these domains. The consistent results prove the beneficial effects of memantine in moderate to severe AD patients.
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Affiliation(s)
- Rainer Hellweg
- Charité Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Berlin, Germany.
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Riepe MW, Janetzky W, Lemming OM. Measuring therapeutic efficacy in patients with Alzheimer's disease: role of instruments. Dement Geriatr Cogn Disord 2011; 31:233-8. [PMID: 21474932 DOI: 10.1159/000326214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Accepted: 02/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Global cognitive scales and meta-analyses thereof are used to appraise therapeutic efficacy over a broad range of disease severity. Clinically, however, different aspects of cognition change in different stages of disease. METHODS Calculation of effect sizes for single cognitive functions on treatment as assessed by the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini-Mental-Status Examination (MMSE), and the Severe Impairment Battery (SIB). In these scales, subdomains of 'cognition', e.g. memory and language, are represented in different proportions. To exemplify the analysis of 'cognition', we used original data of previously published clinical studies with memantine. RESULTS Depending on dementia severity and on the scale used, the effect size for memory varies between -0.44 and +0.34 and for language between -0.40 and +0.26. CONCLUSION Beyond interstudy variance, effect sizes for treatment with antidementia drugs are subject to disease stage, instruments used, and interaction thereof. Therefore, clinical interpretation is necessary to appraise therapeutic efficacy in clinical studies and meta-analyses thereof when patients with different severity are included or different instruments are used. Alternatively, severity-adapted endpoints should be used for appraisal and meta-analysis of therapeutic efficacy.
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Affiliation(s)
- Matthias W Riepe
- Department of Psychiatry and Psychotherapy II, Mental Health and Old Age Psychiatry, Ulm University, Ludwig-Heilmeyer-Strasse 2, Günzburg, Germany.
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Rüther E, Schnitker J, Janetzky W, Friede M. P4‐223: Efficacy of memantine in patients with Alzheimer's disease: Meta‐analyses of 9 clinical trials. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Eckart Rüther
- Institut für Arzneimittelsicherheit in der Psychiatrie e.V.MünchenGermany
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Hellweg R, Wirth Y, Janetzky W, Hartmann S. P4‐221: Efficacy of Memantine in delaying clinical worsening: Responder analyses in patients with moderate to severe Alzheimer's disease. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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