
- Vol 39, Issue 3
Exploring Antipsychotic Dose-Response
Findings from a recent study can help clinicians optimize antipsychotic dosing during acute illness exacerbations.
RESEARCH UPDATE
Disease burden and disability among patients with schizophrenia is largely determined by the negative symptoms, which include blunted affect, alogia, avolition, asociality, and anhedonia.1 In addition, it has been estimated that about 60% of patients with
To gain a better understanding, Michel Sabe, MD, and colleagues conducted a systematic review and dose-response meta-analysis of double-blind randomized controlled trials (RCTs) of fixed antipsychotic doses for negative and positive symptoms in acute exacerbations of (chronic) schizophrenia or
From 4398 articles, the authors identified 612 articles for full-text review, of which 40 met the inclusion/exclusion criteria. These 40 trials included 15,689 patients with a mean illness duration of 14 years, and investigated 13 oral and 3 long-acting injectable antipsychotics. The median study duration was 6 weeks (range, 4-13). The
Based on this data, the resulting dose-response curve types could be trichotomized into: (1) plateau after an initial increase, (2) still increasing at the maximum dose, and (3) bell-shaped. Most of the dose-response curves suggested that the ED95 may be in the low to medium range of approved doses. For most antipsychotics with a plateau-shaped dose response curve (the most common pattern), the ED95 was lower for negative than positive symptoms, except for
Sabe et al acknowledged that the primary limitations of their analyses were the small number of RCTs and limited dose range investigated for some antipsychotics. Another limitation of the study was the absence of RCTs of
The Bottom Line
Findings can help clinicians optimize antipsychotic dosing during acute illness exacerbations. Antipsychotic doses above the ED95 may not confer additional efficacy for most agents.
Dr Miller is a professor in the Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia. He is on the Editorial Board and serves as the schizophrenia section chief for Psychiatric Times™. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, and the Stanley Medical Research Institute.
References
1. Correll CU, Schooler NR.
2. Marder SR, Davidson M, Zaragoza S, et al.
3. Leucht S, Crippa A, Siafis S, et al.
4. Sabe M, Zhao N, Crippa A, et al.
Articles in this issue
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Research Roundup: Psychiatric Comorbidities in the Newsover 3 years ago
Best Recent Screen Portrayals of Mental Health Issuesover 3 years ago
Chronic Kidney Disease and Lithium—A New Perspectiveover 3 years ago
Optogenetics and Piercing the Professional Armorover 3 years ago
“Inappropriate” Consults: Taxonomy and Strategyover 3 years ago
The Assessment of Depression Among Older Adultsover 3 years ago
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