Antipsychotic medication, functional outcome and quality of life in schizophrenia: focus on amisulpride

Abstract

Background:

Restoration of quality of life is considered as the ultimate treatment goal in the management of schizophrenia and is important for destigmatising the disease. However, few studies, including the most recent, have collected quality of life data prospectively or evaluated the relationship of treatment with quality of life.

Scope:

Amisulpride is an atypical antipsychotic drug which has been described to have potency in improving negative symptoms of chronic schizophrenia and whose use is associated with a relatively low rate of emergence of extrapyramidal side-effects. These properties may contribute to a beneficial effect on quality of life. A systematic literature review of functional outcome in clinical trials with amisulpride was performed in order to assess the effect of this drug on quality of life and social functioning in patients. The Medline database was searched for all studies of amisulpride in schizophrenia which reported functional and quality of life outcomes up until 30 September 2009.

Findings:

Only one dedicated study assessing functional outcome or quality of life as a primary outcome criterion was identified. This demonstrated significant improvement in subjective well-being in patients with schizophrenia initiating treatment with amisulpride, and a correlation between this improvement and amelioration of psychopathology. In addition, functional outcome rating scales were used as secondary outcome measures in eight randomised clinical trials, and two naturalistic observational studies. Amisulpride treatment was associated with improvement in functional outcome, with effect sizes that were comparable between studies. Improvements in functional outcome are consistently greater than those observed in patients treated with haloperidol and similar in magnitude to those seen with three other atypical antipsychotics, namely olanzapine, ziprasidone and risperidone. A patient-reported outcome measure was used in only one comparative study, and demonstrated perception of a superior benefit with amisulpride compared to haloperidol. These findings could to some extent be replicated in several large naturalistic studies under standard conditions of care.

Conclusions:

The data from studies on functional outcome and subjective well-being provide consistent information supporting the use of amisulpride for the treatment of schizophrenia in order to improve social functioning, integration into the community and autonomy, which are critical for the overall quality of life of patients with schizophrenia.

Key words::

• Amisulpride
• Functional outcome
• Psychometric rating scales
• Quality of life
• Schizophrenia

Transparency

Declaration of funding

The idea for this article arose through conversations between P.N. and the medical affairs department of sanofi-aventis, manufacturers of amisulpride. Sanofi-aventis funded editorial support provided to the authors. Neither author received funding for the preparation of this review. Sanofi-aventis provided all documentation requested by the authors.

Declaration of financial/other relationships

P.N. has disclosed acting as a consultant for, receiving grants from, or participating in the speakers bureau of the following companies who have an interest in schizophrenia: Bristol-Myers Squibb, Janssen, Lilly, sanofi-aventis and Servier. C.T. has disclosed receiving research funds from Janssen Laboratories.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed serving on an advisory board for Eli Lilly. Peer Reviewer 2 has disclosed no relevant financial relationships.

Acknowledgements

Editorial support for this article was provided by Adam Doble, SARL Foxymed, Fresnes funded by sanofi-aventis. Publication assistance from Content Ed Net Comms is gratefully acknowledged.