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Switching Patients with Stable Schizophrenia or Schizoaffective Disorder from Olanzapine to Risperidone Long-Acting Injectable

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Abstract

Background: Patients with schizophrenia or related disorders often switch antipsychotic therapy, most commonly due to lack of efficacy and side effects. The differences in anticipated efficacy and tolerability among atypical antipsychotics may drive switching behaviours. Switching to long-acting antipsychotics may improve adherence. Improving adherence is essential as relatively short medication gaps significantly increase the risk of schizophrenia hospitalizations. Long-term treatment with risperidone long-acting injectable (RLAI), the first available long-acting atypical antipsychotic, versus oral atypical antipsychotics showed better adherence with RLAI. Stable patients with schizophrenia or related disorders treated with a stable dose of antipsychotic showed improved efficacy when switched to flexible doses of RLAI. The most common reason for patients to switch from olanzapine to another antipsychotic is excessive weight gain. Metabolic dysfunction also occurs more commonly with olanzapine than with risperidone. Patients switching from olanzapine to risperidone experienced significant decreases in body weight, body mass index and triglyceride levels, whereas patients switching from risperidone to olanzapine experienced significant increases in body weight and triglyceride levels. The efficacy, tolerability and safety of RLAI in non-acute patients with schizophrenia or schizoaffective disorder previously treated with oral olanzapine needs to be explored.

Objective: The objective of this study was to evaluate the efficacy, tolerability and safety of switching from oral olanzapine to RLAI.

Methods: This was a six-month, prospective, multicentre, non-randomized, single-arm, open-label trial. The trial evaluated non-acute adult patients with psychotic disorders treated with a stable olanzapine dose who required a treatment change. Three weeks after RLAI initiation, olanzapine was tapered off over 1 week or 3 weeks.

Efficacy and safety measures included the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S), Global Assessment of Functioning (GAF) and treatment-emergent adverse events (TEAEs).

Results: Among 96 patients analysed, significant endpoint efficacy changes versus baseline were observed for PANSS, CGI-S and GAF (all p< 0.0001). PANSS total score improvement was ≥20% for 65.6% of patients and ≥50% for 31.3%. TEAEs were similar in the 1- and 3-week taper groups (40.0% and 46.5%, respectively). TEAEs were generally mild (34.5%) or moderate (49.0%) in intensity.

Conclusion: Switching non-acute patients with schizophrenia or schizoaffective disorder requiring a treatment change from a stable dose of oral olanzapine to RLAI improved psychiatric symptom control, functioning and patient treatment satisfaction. RLAI was generally well tolerated.

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Acknowledgements

The authors wish to thank Tam Vo, PhD, and the team from Excerpta Medica for provided editorial and writing assistance.

Disclosures

Funding: The study and editorial/writing support were funded by Janssen Pharmaceutical Companies of Johnson & Johnson in EMEA.

Role of funding source: Janssen Pharmaceutical Companies of Johnson & Johnson in EMEA designed the study, and was responsible for data collection. Contracted CRO was responsible for trial management, statistical planning and analyses. Editorial and writing assistance was funded by the sponsor. The authors are fully responsible for all content, editorial decisions and opinions expressed in this study. The sponsor suggested the journal for submission and all authors have agreed to the submission.

Conflicts of interest: Dr Rosa has no conflicts of interest to declare.

Dr Schreiner is a full-time employee of Janssen-Cilag Medical Affairs EMEA.

Prof. Thomas has received honoraria from: BMS–Otsuka; Janssen-Cilag; Lilly; sanofi-aventis; and Servier.

Dr Sherif has no conflicts of interest to declare.

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Authors and Affiliations

  1. Casa de Saúde S. Rafael, Rua Dr. Aníbal Bettencourt, Santa Luzia, 9700-161 Angra do Heroísmo, Portugal

    Fernanda Rosa (Clinical Director)

  2. Janssen-Cilag GmbH, Neuss, Germany

    Andreas Schreiner

  3. University Hospital Center of Lille, Lille, France

    Pierre Thomas

  4. National Guard Health Affairs Jeddah, King Khalid National Guard Hospital, Jeddah, Saudi Arabia

    Tarek Sherif (Head of Department of Psychiatry)

Authors
  1. Fernanda Rosa
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  2. Andreas Schreiner
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  3. Pierre Thomas
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  4. Tarek Sherif
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Correspondence to Fernanda Rosa.

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Rosa, F., Schreiner, A., Thomas, P. et al. Switching Patients with Stable Schizophrenia or Schizoaffective Disorder from Olanzapine to Risperidone Long-Acting Injectable. Clin Drug Investig 32, 267–279 (2012). https://doi.org/10.2165/11599080-000000000-00000

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  • DOI: https://doi.org/10.2165/11599080-000000000-00000

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