Antipsychotic switching in schizoaffective disorder: A systematic review

Abstract

Objectives. To systematically review the evidence about the switching of antipsychotics in SZA in acute and maintenance treatment. Methods. A systematic review following the PRISMA statement identifying studies specifically conducted on, or including, SZA patients. Results. One analysis considered uniquely a SZA population, 13 more studies including an adequate SZA subsample were considered. Most of the studies were aimed at switching antipsychotic treatments to improve tolerability issues. Despite the absolute lack of trials specifically conducted on SZA populations, we found limited evidence on the use of aripiprazole, lurasidone, and, to a lesser extent, risperidone and ziprasidone as possible agents to substitute previous treatments whereas efficacy or, more frequently, tolerability issues arise. Evidence supports also the switch to risperidone long-acting injectable when the adherence to oral treatment may be a concern. Conclusions. Antipsychotic switching in SZA is a neglected topic that would need better profiling. Clinicians should keep in mind the receptor binding characteristics of drugs in order to optimize transitions. Evidence supports the switch to aripiprazole and lurasidone, less strongly to risperidone and ziprasidone. The switch to risperidone long-acting injectable is supported, especially in patients with limited treatment adherence to oral therapy.

Key words::

• schizoaffective disorder
• switching strategy
• antipsychotics
• systematic review
• PRISMA statement

Acknowledgements

This study received grant support from the Fundación Española de Psiquiatria y Salud Mental.

Statement of Interest

Dr. Andrea Murru has received support from Bristol-Myers-Squibb and has been speaker for Adamed, Astra Zeneca, Janssen-Cilag and Otsuka. Dr. Diego Hidalgo has no conflicts of interest to declare. Prof. Miguel Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of Abibiotic, Adamed, Almirall, AMGEN, Eli Lilly, Ferrer, Hersill, Gedeon, Janssen-Cilag, Lunbeck, Otsuka, Pfizer, Roche, Servier and has obtained research funding from: CIBERSAM, Generalitat de Catalunya, Ministerio de Ciencia e innovación, Ministerio de Educación (FIS, ISCIII), IDIBAPS, the 7th Framework program of the European Union. Prof. Julio Bobes has received consulting fees and honoraria from Adamed, Almirall, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Glaxo- Smith-Kline, Janssen-Cilag, Lundbeck, Merck, Novartis, Organon, Otsuka, Pfizer, Pierre-Fabre, Sanofi-Aventis, Servier, Shering-Plough and Wyeth. Prof. Jerónimo Saiz-Ruiz has been a speaker for and on the advisory boards of Lilly, GlaxoSmithKline, Lundbeck, Janssen, Servier and Pfizer; and has received grant/honoraria from Lilly, Astra-Zeneca, Bristol-Myers and Wyeth. Prof Cecilio Álamo has been a speaker for and on the advisory boards of Janssen-Cilag, Bristol Myers Squib, Otsuka and Pfizer. Prof. Eduard Vieta has received research grants and served as consultant, advisor or speaker for the companies: Alexza, Almirall, Astra-Zeneca, Bial, Bristol-Myers Squibb, Eli Lilly, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen-Cilag, Jazz, Lundbeck, Merck, Novartis, Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, Solvay, Shire, Takeda, United Biosource Corporation, research funding from the Spanish Ministry of Science and Innovation, the Stanley Medical Research Institute and the 7th Framework program of the European Union.