Early Efficacy of Antipsychotic Medications at Week 2 Predicts Subsequent Responses at Week 6 in a Large-scale Randomized Controlled Trial

Title:Early Efficacy of Antipsychotic Medications at Week 2 Predicts Subsequent Responses at Week 6 in a Large-scale Randomized Controlled Trial

Volume: 21 Issue: 2

Author(s): Yiguo Tang, Yulu Wu, Xiaojing Li, QinJian Hao, Wei Deng, Weihua Yue, Hao Yan, Yamin Zhang, Liwen Tan, Qi Chen, Guigang Yang, Tianlan Lu, Lifang Wang, Fude Yang, Fuquan Zhang, Jianli Yang, Keqing Li, Luxian Lv, Qingrong Tan, Hongyan Zhang, Xin Ma, Lingjiang Li, Chuanyue Wang, Xiaohong Ma, Dai Zhang, Hao Yu, Liansheng Zhao, Hongyan Ren, Yingcheng Wang, Guangya Zhang, Chuanwei Li, Xiangdong Du, Xun Hu, Tao Li*Qiang Wang*

Affiliation:

• Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

• Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
• Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China

Keywords: Antipsychotics, early efficacy, subsequent response, predictive capacity, RCT, schizophrenia.

Abstract:

Background: Since the early clinical efficacy of antipsychotics has not yet been well perceived, this study sought to decide whether the efficacy of antipsychotics at week 2 can predict subsequent responses at week 6 and identify how such predictive capacities vary among different antipsychotics and psychotic symptoms.

Methods: A total of 3010 patients with schizophrenia enrolled in a randomized controlled trial (RCT) and received a 6-week treatment with one antipsychotic drug randomly chosen from five atypical antipsychotics (risperidone 2-6 mg/d, olanzapine 5-20 mg/d, quetiapine 400-750 mg/d, aripiprazole 10-30 mg/d, and ziprasidone 80-160 mg/d) and two typical antipsychotics (perphenazine 20-60 mg/d and haloperidol 6-20 mg/d). Early efficacy was defined as the reduction rate using the Positive and Negative Syndrome Scale (PANSS) total score at week 2. With cut-offs at 50% reduction, logistic regression, receiver operating characteristic (ROC) and random forests were adopted.

Results: The reduction rate of PANSS total score and improvement of psychotic symptoms at week 2 enabled subsequent responses to 7 antipsychotics to be predicted, in which improvements in delusions, lack of judgment and insight, unusual thought content, and suspiciousness/ persecution were endowed with the greatest weight.

Conclusion: It is robust enough to clinically predict treatment responses to antipsychotics at week 6 using the reduction rate of PANSS total score and symptom relief at week 2. Psychiatric clinicians had better determine whether to switch the treatment plan by the first 2 weeks.

Cite this article as:

Tang Yiguo, Wu Yulu, Li Xiaojing, Hao QinJian, Deng Wei, Yue Weihua, Yan Hao, Zhang Yamin, Tan Liwen, Chen Qi, Yang Guigang, Lu Tianlan, Wang Lifang, Yang Fude, Zhang Fuquan, Yang Jianli, Li Keqing, Lv Luxian, Tan Qingrong, Zhang Hongyan, Ma Xin, Li Lingjiang, Wang Chuanyue, Ma Xiaohong, Zhang Dai, Yu Hao, Zhao Liansheng, Ren Hongyan, Wang Yingcheng, Zhang Guangya, Li Chuanwei, Du Xiangdong, Hu Xun, Li Tao*, Wang Qiang*, Early Efficacy of Antipsychotic Medications at Week 2 Predicts Subsequent Responses at Week 6 in a Large-scale Randomized Controlled Trial, Current Neuropharmacology 2023; 21 (2) . https://dx.doi.org/10.2174/1570159X21666221118164612