Long-acting injectable risperidone and metabolic ratio: A possible index of clinical outcome in treatment-resistant schizophrenic patients

Lucia Sara Volonteri, Giancarlo Cerveri, Ilaria Francesca De Gaspari, Maria Luisa Baldi, Maria Laura Rolandi, Pietro Papa, Massimo Carlo Mauri, Claudio Mencacci

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Rationale: It is still common to encounter a partial or no response to antipsychotic treatment in clinical practice, but only individual case reports are currently available concerning the efficacy of long-acting risperidone (RLAI) in treatmentresistant schizophrenia. The relationship between RSP and 9-OH-RSP plasma levels, and clinical response or tolerability has not yet been thoroughly assessed. Methods This open-label, non-randomised study involved 30 outpatients with treatment-resistant schizophrenia, who were prescribed RLAI for 6 months, and clinically evaluated using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Symptoms Scale (PANSS), the Clinical Global Impression-Improvement Scale (CGI-I), and the Simpson and Angus Scale for Extrapyramidal Side Effects (EPSE). Plasma RSP and 9-OH-RSP levels were determined at steady-state, and the metabolic ratio (MR) was calculated as plasma 9-OH-RSP/RSP levels. Results At the end of the study, 60% of the patients responded to RLAI (a ≥20% reduction in the PANSS score). Linear regression analysis showed a significant positive relationship between the RSP dose and active moiety (RSP+9-OH-RSP) (r=0.4; p=0.02). There was a significant positive relationship between active moiety and EPSE scores (r=0.6; p=0.00). The BPRS responders had a significantly higher mean MR than the non-responders (3.41±1.87 SD vs 1.60±0.98 SD) (p=0.00). Conclusions Therapeutic drug monitoring seems to be useful in optimising the dose of RLAI, especially in the case of tolerability problems. MR might be a better index of clinical response to RLAI than the value of the active moiety, although this needs to be confirmed by further data.

Original languageEnglish
Pages (from-to)489-497
Number of pages9
JournalPsychopharmacology
Volume210
Issue number4
DOIs
Publication statusPublished - Jul 2010

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Risperidone
Brief Psychiatric Rating Scale
Injections
Schizophrenia
Drug Monitoring
Antipsychotic Agents
Linear Models
Outpatients
Regression Analysis
hydroxide ion
Therapeutics

Keywords

  • Long-acting risperidone
  • Metabolic ratio
  • Plasma levels
  • Treatment-resistant schizophrenia

ASJC Scopus subject areas

  • Pharmacology

Cite this

Long-acting injectable risperidone and metabolic ratio : A possible index of clinical outcome in treatment-resistant schizophrenic patients. / Volonteri, Lucia Sara; Cerveri, Giancarlo; De Gaspari, Ilaria Francesca; Baldi, Maria Luisa; Rolandi, Maria Laura; Papa, Pietro; Mauri, Massimo Carlo; Mencacci, Claudio.

In: Psychopharmacology, Vol. 210, No. 4, 07.2010, p. 489-497.

Research output: Contribution to journalArticle

Volonteri, Lucia Sara ; Cerveri, Giancarlo ; De Gaspari, Ilaria Francesca ; Baldi, Maria Luisa ; Rolandi, Maria Laura ; Papa, Pietro ; Mauri, Massimo Carlo ; Mencacci, Claudio. / Long-acting injectable risperidone and metabolic ratio : A possible index of clinical outcome in treatment-resistant schizophrenic patients. In: Psychopharmacology. 2010 ; Vol. 210, No. 4. pp. 489-497.
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abstract = "Rationale: It is still common to encounter a partial or no response to antipsychotic treatment in clinical practice, but only individual case reports are currently available concerning the efficacy of long-acting risperidone (RLAI) in treatmentresistant schizophrenia. The relationship between RSP and 9-OH-RSP plasma levels, and clinical response or tolerability has not yet been thoroughly assessed. Methods This open-label, non-randomised study involved 30 outpatients with treatment-resistant schizophrenia, who were prescribed RLAI for 6 months, and clinically evaluated using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Symptoms Scale (PANSS), the Clinical Global Impression-Improvement Scale (CGI-I), and the Simpson and Angus Scale for Extrapyramidal Side Effects (EPSE). Plasma RSP and 9-OH-RSP levels were determined at steady-state, and the metabolic ratio (MR) was calculated as plasma 9-OH-RSP/RSP levels. Results At the end of the study, 60{\%} of the patients responded to RLAI (a ≥20{\%} reduction in the PANSS score). Linear regression analysis showed a significant positive relationship between the RSP dose and active moiety (RSP+9-OH-RSP) (r=0.4; p=0.02). There was a significant positive relationship between active moiety and EPSE scores (r=0.6; p=0.00). The BPRS responders had a significantly higher mean MR than the non-responders (3.41±1.87 SD vs 1.60±0.98 SD) (p=0.00). Conclusions Therapeutic drug monitoring seems to be useful in optimising the dose of RLAI, especially in the case of tolerability problems. MR might be a better index of clinical response to RLAI than the value of the active moiety, although this needs to be confirmed by further data.",
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AU - Volonteri, Lucia Sara

AU - Cerveri, Giancarlo

AU - De Gaspari, Ilaria Francesca

AU - Baldi, Maria Luisa

AU - Rolandi, Maria Laura

AU - Papa, Pietro

AU - Mauri, Massimo Carlo

AU - Mencacci, Claudio

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AB - Rationale: It is still common to encounter a partial or no response to antipsychotic treatment in clinical practice, but only individual case reports are currently available concerning the efficacy of long-acting risperidone (RLAI) in treatmentresistant schizophrenia. The relationship between RSP and 9-OH-RSP plasma levels, and clinical response or tolerability has not yet been thoroughly assessed. Methods This open-label, non-randomised study involved 30 outpatients with treatment-resistant schizophrenia, who were prescribed RLAI for 6 months, and clinically evaluated using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Symptoms Scale (PANSS), the Clinical Global Impression-Improvement Scale (CGI-I), and the Simpson and Angus Scale for Extrapyramidal Side Effects (EPSE). Plasma RSP and 9-OH-RSP levels were determined at steady-state, and the metabolic ratio (MR) was calculated as plasma 9-OH-RSP/RSP levels. Results At the end of the study, 60% of the patients responded to RLAI (a ≥20% reduction in the PANSS score). Linear regression analysis showed a significant positive relationship between the RSP dose and active moiety (RSP+9-OH-RSP) (r=0.4; p=0.02). There was a significant positive relationship between active moiety and EPSE scores (r=0.6; p=0.00). The BPRS responders had a significantly higher mean MR than the non-responders (3.41±1.87 SD vs 1.60±0.98 SD) (p=0.00). Conclusions Therapeutic drug monitoring seems to be useful in optimising the dose of RLAI, especially in the case of tolerability problems. MR might be a better index of clinical response to RLAI than the value of the active moiety, although this needs to be confirmed by further data.

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