TY - JOUR
T1 - Antipsychotic treatment strategies for acute phase and treatment resistance in schizophrenia
T2 - A systematic review of the guidelines and algorithms
AU - Shimomura, Yutaro
AU - Kikuchi, Yuhei
AU - Suzuki, Takefumi
AU - Uchida, Hiroyuki
AU - Mimura, Masaru
AU - Takeuchi, Hiroyoshi
N1 - Funding Information:
Dr. Uchida has received grants from Daiichi Sankyo, Eisai, Meiji Seika Pharma, Mochida, Otsuka, and Sumitomo Dainippon Pharma; speaker's honoraria from Eisai, Meiji Seika Pharma, Otsuka, and Sumitomo Dainippon Pharma; and advisory panel payments from Sumitomo Dainippon Pharma.
Funding Information:
Dr. Mimura has grants from Daiichi Sankyo, Eisai, Mitsubishi Tanabe Pharma, Pfizer, Shionogi, Takeda, and Tsumura; and speaker's fees from Daiichi Sankyo, Eisai, Eli Lilly, Fujifilm RI Pharma, Janssen, Mochida, MSD, Nippon Chemiphar, Novartis Pharma, Ono, Otsuka, Pfizer, Sumitomo Dainippon Pharma, Takeda, Tsumura, and Yoshitomiyakuhin.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/10
Y1 - 2021/10
N2 - Background: To summarize the current state of knowledge on antipsychotic treatment strategies for the acute phase and treatment resistance in schizophrenia, we conducted a systematic review of guidelines and algorithms. Methods: We conducted a systematic literature search to identify clinical guidelines and algorithms on this topic using MEDLINE and Embase. We extracted information on recommendations for antipsychotic treatment strategies, including those for non-response (i.e., increasing antipsychotic dose and switching to another antipsychotic) and treatment resistance. Results: We identified a total of 17 guidelines/algorithms in various countries that were published after 2011. With respect to antipsychotic dose, most of the guidelines (N = 10/11) agreed starting with a low dose or the lowest licensed/effective dose and then titrating the dose upwards. Regarding antipsychotic treatment strategies for non-response, all of the guidelines (N = 9/9) recommended increasing antipsychotic dose towards the upper end of its approved dose range. Five guidelines suggested for increasing beyond the therapeutic dose range in exceptional cases, while overall 10 guidelines including them were negative about such strategy. The vast majority of guidelines (N = 16/17) recommended switching to another antipsychotic for non-response; however, some guidelines mentioned the lack of evidence for these strategies other than the use of clozapine. All the guidelines (N = 17/17) endorsed initiating clozapine after failure to respond to 2 different antipsychotics. Four guidelines endorsed an early use of clozapine, yet as the third antipsychotic. Conclusion: The currently available guidelines and algorithms recommended increasing antipsychotic dose and switching to another antipsychotic, particularly clozapine for treatment-resistant schizophrenia, during the acute phase of schizophrenia for non-response.
AB - Background: To summarize the current state of knowledge on antipsychotic treatment strategies for the acute phase and treatment resistance in schizophrenia, we conducted a systematic review of guidelines and algorithms. Methods: We conducted a systematic literature search to identify clinical guidelines and algorithms on this topic using MEDLINE and Embase. We extracted information on recommendations for antipsychotic treatment strategies, including those for non-response (i.e., increasing antipsychotic dose and switching to another antipsychotic) and treatment resistance. Results: We identified a total of 17 guidelines/algorithms in various countries that were published after 2011. With respect to antipsychotic dose, most of the guidelines (N = 10/11) agreed starting with a low dose or the lowest licensed/effective dose and then titrating the dose upwards. Regarding antipsychotic treatment strategies for non-response, all of the guidelines (N = 9/9) recommended increasing antipsychotic dose towards the upper end of its approved dose range. Five guidelines suggested for increasing beyond the therapeutic dose range in exceptional cases, while overall 10 guidelines including them were negative about such strategy. The vast majority of guidelines (N = 16/17) recommended switching to another antipsychotic for non-response; however, some guidelines mentioned the lack of evidence for these strategies other than the use of clozapine. All the guidelines (N = 17/17) endorsed initiating clozapine after failure to respond to 2 different antipsychotics. Four guidelines endorsed an early use of clozapine, yet as the third antipsychotic. Conclusion: The currently available guidelines and algorithms recommended increasing antipsychotic dose and switching to another antipsychotic, particularly clozapine for treatment-resistant schizophrenia, during the acute phase of schizophrenia for non-response.
KW - Algorithms
KW - Antipsychotics
KW - Guidelines
KW - Non-response
KW - Schizophrenia
KW - Treatment resistance
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U2 - 10.1016/j.schres.2021.07.040
DO - 10.1016/j.schres.2021.07.040
M3 - Article
C2 - 34509129
AN - SCOPUS:85114437130
SN - 0920-9964
VL - 236
SP - 142
EP - 155
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -
