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Abstract
Background:
Aripiprazole is an atypical antipsychotic with a pharmacological and clinical profile distinct from other atypical antipsychotics.
Scope:
A European multidisciplinary advisory panel of university-based experts in bipolar disorders convened in April 2010 to review new clinical guidelines for the management of mania and the role of aripiprazole in its treatment. This report describes the consensus reached on how best to use aripiprazole in the treatment of mania.
Findings:
Current guidelines recommending aripiprazole for first-line treatment of mania have not generally translated to clinical practice. The panel agreed that clinicians may not feel sufficiently knowledgeable on how to use aripiprazole effectively in mania, and that the perception that aripiprazole is less sedating than other antipschotics may hamper its use. There was consensus about the importance of ensuring that clinicians understood the distinction between antimanic efficacy and sedation. Most acutely manic patients may require night-time sedation, but continuous daytime sedation is not necessarily indicated and may interfere with long-term compliance. If sedation is necessary, guidelines recommend the use of adjunctive benzodiazepines only for a short-time.
Conclusions:
Clinical practice guidelines widely recommend aripiprazole as a first-line treatment for mania. Although clinical trials may not represent all patient subpopulations, they show that aripiprazole is well tolerated and has a long-term stabilizing potential. The successful use of aripiprazole rests on using the appropriate initial dose, titrating and adjusting the dose as needed and using appropriate concomitant medication to minimize any short-term adverse events. Low incidence of sedation makes aripiprazole a reasonable long-term treatment choice. If short-term sedation is required an adjunctive sedative agent can be added and removed when no longer needed. Clinical considerations should influence treatment choice, and a better distinction between sedation and antimanic effects should be an educational target aimed to overcome potential barriers for using non-sedative antimanic agents such as aripiprazole.
Transparency
Declaration of funding
Bristol-Myers Squibb funded the consensus meeting from which this paper was generated; Funding for the editorial support on this manuscript was also provided Bristol-Myers Squibb.
Declaration of financial/other relationships
M.A. has disclosed that he has received consulting fees or honoraria from AstraZeneca, Bristol-Myers Squibb, Cephalon, Dainippon Sumitomo Pharma, Elli Lilly, Euthérapie, Janssen, Lundbeck, and Sanofi Aventis. H.Å. has disclosed that he has received honoraria for lectures and/or served as a member of the advisory board of Bristol-Myers Squibb, AstraZeneca, H. Lundbeck AB, Lilly, Servier, and GSK. F.B. has disclosed that he has received honoraria for lectures and/or served as a member of the advisory board of Bristol-Myers Squibb, AstraZeneca, H. Lundbeck AB, Lilly, Servier, and Sanofi-Aventis. K.N.F. has disclosed that he has received honoraria for lectures from AstraZeneca, Janssen-Cilag, Eli Lilly, Elpen, Servier, and research grants from AstraZeneca and Pfizer Foundation. G.M.G. has disclosed that he has held grants from Sanofi-Aventis and Servier, received honoraria for speaking or chairing educational meetings from AstraZeneca, Bristol-Myers Squibb, Eisai, Lundbeck, Sanofi-Aventis and Servier, and advised AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Janssen-Cilag, Lilly, Lundbeck, P1vital, Roche, Sanofi-Aventis, Servier and Wyeth. He holds shares in P1vital and acted as expert witness for Lilly and Servier. H.G. has disclosed that he has received grants/research support, consulting fees and honoraria within the last 3 years from Astra Zeneca, Bial, BMS, Cephalon, Eli Lilly, Gedeon Richter, Janssen-Cilag, Merck, NHS National Institute For Health Research/Medical Research Council UK, Organon, Pfizer Inc., Sanofi-Aventis, Sepracor, Servier and UBC. R.W.L. has disclosed that he, within the last 3 years, has received unrestricted grant support, honoraria or travel fees or served as an advisory board member for Bristol-Myers Squibb, AstraZeneca, MSD, GlaxoSmithKline, Eli Lilly, Janssen-Cilag, and Pfizer. W.P. has disclosed that he has received unrestricted grant support or served as an advisory board member or speaker for AstraZeneca, Bristol-Myers Squibb, Servier, and Eli Lilly. T.E.S. has disclosed that he, within the last 2 years, has received honoraria or travel fees or served as an advisory board member for Bristol-Myers Squibb, Astra-Zeneca, Eli Lilly, and PNB Inc. (Belgium). E.V. has disclosed that he has received grants and served as consultant, advisor or speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Research Institute, Geodon Richter, GlaxoSmithKline, Janssen-Cilag, Jazz, Lundbeck, Merck, Novartis, Organon, Otsuka, Pfizer, Pierre-Fabre, Qualigen, Sanofi-Aventis, Servier, Schering-Plough, Solvay, Takeda, the Spanish Ministry of Science and Innovation (CIBERSAM), the Seventh European Framework Programme (ENBREC), the Stanley Medical Research Institute, United Biosource Corporation, and Wyeth. A.C.A. has disclosed that he has been a consultant to Merck, AstraZeneca, Bristol-Myers Squibb and Janssen-Cilag; and is on the Speakers’ Bureau of Sanofi-Aventis, Eli Lilly and Pfizer. E.H.-T. has disclosed that she has no relevant financial relationships.
CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.
Acknowledgements
Editorial assistance was provided by Ogilvy Healthworld Medical Education.