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Effectiveness of lurasidone in patients with schizophrenia or schizoaffective disorder switched from other antipsychotics: a randomized, 6-week, open-label study.
J Clin Psychiatry. 2013 Feb; 74(2):170-9.JC

Abstract

OBJECTIVE

To examine the effectiveness of switching patients to lurasidone using 3 different dosing strategies.

METHOD

Adults with DSM-IV-defined schizophrenia or schizoaffective disorder in a nonacute phase of illness were randomized to 1 of 3 lurasidone dosing regimens for the initial 2 weeks of the study: (1) 40 mg/d for 2 weeks; (2) 40 mg/d for 1 week, increased to 80 mg/d on day 8 for week 2 (up-titration group); and (3) 80 mg/d for 2 weeks. Lurasidone was then flexibly dosed (40-120 mg/d) for the subsequent 4 weeks of the study. The preswitch antipsychotic agent was tapered by day 7 to 50% of the original dose and discontinued by the end of week 2. Subjects were stratified on the basis of whether the primary preswitch antipsychotic medication was classified as "sedating" (olanzapine or quetiapine) or "nonsedating" (all other antipsychotics). The primary outcome measure was time to treatment failure, defined as any occurrence of insufficient clinical response, exacerbation of underlying disease, or discontinuation due to an adverse event. The study was conducted from June 2010 to May 2011.

RESULTS

Of 240 subjects treated in this study, 86 (35.8%) were treated with an antecedent sedating antipsychotic, and 154 (64.2%) were treated with an antecedent nonsedating antipsychotic. Nineteen (7.9%) of the 240 patients experienced treatment failure. No clinically relevant differences were observed when the 3 randomized switch groups were compared. Treatment failure rates were 10/86 (11.6%) versus 9/154 (5.8%) among subjects who had been receiving a preswitch sedating versus nonsedating antipsychotic medication, respectively. Consistent with prior studies of lurasidone, there was no signal for clinically relevant adverse changes in body weight, glucose, insulin, lipids, or prolactin; mean improvements in weight and lipids were observed. Movement disorder rating scales did not demonstrate meaningful changes. The incidence of akathisia as an adverse event was 12.5%; only 1 subject (0.4%) discontinued due to akathisia.

CONCLUSIONS

Switching patients to lurasidone can be successfully accomplished by starting at 40 mg/d for 2 weeks, or 80 mg/d for 2 weeks, or 40 mg/d for 1 week followed by 80 mg/d the second week.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01143077.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23473350

Citation

McEvoy, Joseph P., et al. "Effectiveness of Lurasidone in Patients With Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics: a Randomized, 6-week, Open-label Study." The Journal of Clinical Psychiatry, vol. 74, no. 2, 2013, pp. 170-9.
McEvoy JP, Citrome L, Hernandez D, et al. Effectiveness of lurasidone in patients with schizophrenia or schizoaffective disorder switched from other antipsychotics: a randomized, 6-week, open-label study. J Clin Psychiatry. 2013;74(2):170-9.
McEvoy, J. P., Citrome, L., Hernandez, D., Cucchiaro, J., Hsu, J., Pikalov, A., & Loebel, A. (2013). Effectiveness of lurasidone in patients with schizophrenia or schizoaffective disorder switched from other antipsychotics: a randomized, 6-week, open-label study. The Journal of Clinical Psychiatry, 74(2), 170-9. https://doi.org/10.4088/JCP.12m07992
McEvoy JP, et al. Effectiveness of Lurasidone in Patients With Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics: a Randomized, 6-week, Open-label Study. J Clin Psychiatry. 2013;74(2):170-9. PubMed PMID: 23473350.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of lurasidone in patients with schizophrenia or schizoaffective disorder switched from other antipsychotics: a randomized, 6-week, open-label study. AU - McEvoy,Joseph P, AU - Citrome,Leslie, AU - Hernandez,David, AU - Cucchiaro,Josephine, AU - Hsu,Jay, AU - Pikalov,Andrei, AU - Loebel,Antony, PY - 2012/07/01/received PY - 2012/12/12/accepted PY - 2013/3/12/entrez PY - 2013/3/12/pubmed PY - 2013/4/30/medline SP - 170 EP - 9 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 74 IS - 2 N2 - OBJECTIVE: To examine the effectiveness of switching patients to lurasidone using 3 different dosing strategies. METHOD: Adults with DSM-IV-defined schizophrenia or schizoaffective disorder in a nonacute phase of illness were randomized to 1 of 3 lurasidone dosing regimens for the initial 2 weeks of the study: (1) 40 mg/d for 2 weeks; (2) 40 mg/d for 1 week, increased to 80 mg/d on day 8 for week 2 (up-titration group); and (3) 80 mg/d for 2 weeks. Lurasidone was then flexibly dosed (40-120 mg/d) for the subsequent 4 weeks of the study. The preswitch antipsychotic agent was tapered by day 7 to 50% of the original dose and discontinued by the end of week 2. Subjects were stratified on the basis of whether the primary preswitch antipsychotic medication was classified as "sedating" (olanzapine or quetiapine) or "nonsedating" (all other antipsychotics). The primary outcome measure was time to treatment failure, defined as any occurrence of insufficient clinical response, exacerbation of underlying disease, or discontinuation due to an adverse event. The study was conducted from June 2010 to May 2011. RESULTS: Of 240 subjects treated in this study, 86 (35.8%) were treated with an antecedent sedating antipsychotic, and 154 (64.2%) were treated with an antecedent nonsedating antipsychotic. Nineteen (7.9%) of the 240 patients experienced treatment failure. No clinically relevant differences were observed when the 3 randomized switch groups were compared. Treatment failure rates were 10/86 (11.6%) versus 9/154 (5.8%) among subjects who had been receiving a preswitch sedating versus nonsedating antipsychotic medication, respectively. Consistent with prior studies of lurasidone, there was no signal for clinically relevant adverse changes in body weight, glucose, insulin, lipids, or prolactin; mean improvements in weight and lipids were observed. Movement disorder rating scales did not demonstrate meaningful changes. The incidence of akathisia as an adverse event was 12.5%; only 1 subject (0.4%) discontinued due to akathisia. CONCLUSIONS: Switching patients to lurasidone can be successfully accomplished by starting at 40 mg/d for 2 weeks, or 80 mg/d for 2 weeks, or 40 mg/d for 1 week followed by 80 mg/d the second week. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01143077. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/23473350/Effectiveness_of_lurasidone_in_patients_with_schizophrenia_or_schizoaffective_disorder_switched_from_other_antipsychotics:_a_randomized_6_week_open_label_study_ L2 - http://www.psychiatrist.com/jcp/article/pages/2013/v74n02/v74n0210.aspx DB - PRIME DP - Unbound Medicine ER -