Aripiprazole for the treatment of schizophrenia: Recommendations of a panel of Spanish experts on its use in clinical practice

Abstract

Objectives

Aripiprazole is an antipsychotic with a partial agonism of dopamine D₂ and D₃ receptors. This differential mechanism implies a rigorous appraisal of the appropriate therapeutic strategies in certain situations. To answer currently unsolved clinical questions about the use of oral and long-acting injectable (LAI) aripiprazole, we present here an expert consensus from 12 Spanish psychiatrists and a pharmacologist with extensive experience in the use of this antipsychotic.

Methods

Through one face-to-face session and online collaboration, we reached consensus and established practical recommendations based on scientific evidence and clinical experience. We classified the available scientific literature according to SIGN system and attributed a level of evidence to each reviewed article.

Results

The recommendations were divided according to (i) chronological dimension (based on previous treatments, including patients naïve or not to antipsychotic treatment and maintenance regimen), and (ii) dimension related to therapeutic options, comprising switches to aripiprazole and the most used combinations with this antipsychotic.

Conclusions

We recommend considering aripiprazole as first treatment option in the early stages of schizophrenia and in patients with affective symptoms and contemplating a switch to aripiprazole LAI in all candidate patients. Importantly, switches from other antipsychotics should consider previous antipsychotic history and exposure to aripiprazole.

KEYPOINTS

• Aripiprazole can be considered as first treatment option in early stages of schizophrenia and in patients with significant affective symptoms.

• Aripiprazole LAI shows better adherence than oral aripiprazole and could be considered in all candidate patients.

• Before switching to aripiprazole, detailed information about previous antipsychotic history should be gathered.

• Switch to aripiprazole should be managed differently for aripiprazole naïve and non-naïve patients.

• Rigorous and controlled studies on antipsychotics in real clinical practice should be carried out.

Keywords:

• Aripiprazole
• schizophrenia
• antipsychotics
• long-acting injectable
• switch

Acknowledgement

Medical writing services were provided by Matías Rey-Carrizo, PhD, on behalf Springer Healthcare.

Disclosure statement

DF has received funding as an advisor or speaker from Angelini, Casen Recordati, Janssen, Lundbeck, and Otsuka. He has also received research funds from the Instituto de Salud Carlos III (Ministry of Science and Innovation) and the Fundación Alicia Koplowitz. SAE has been an advisor or has received honoraria or grants from Janssen, Casen Recordati, Otsuka, Lundbeck, Ferrer, Pfizer, Adamed, Exeltis, Neuraxpharm, Bial, Esteve, Servier, and Angelini. MGR has received funding as an advisor or speaker from Otsuka, Lündbeck, Janssen, Pfizer, Servier, Angelini, Recordati, Lilly, Adamed, Alter and Italfarmaco. CGSL has been an advisor or has received honoraria or grants from Adamed, Janssen, Lundbeck, and Otsuka. DHH has been an advisor or has received honoraria or grants from Janssen, Casen Recordati, Otsuka, Lundbeck, Ferrer, Servier, and Angelini. DNA has received honoraria or grants from Otsuka, Lundbeck, Angelini and Casen Recordati. BOPG has been a consultant or has received fees for collaborations from Lundbeck, Janssen, Casen Recordati, Pfizer, and Servier. CPT has been a consultant or has received fees for collaborations from Lundbeck, Janssen, MSD, Esteve, and Casen Recordati. SLRG has been a consultant or has received honoraria for collaborations from Lundbeck, Janssen, Pfizer, and Servier. ERC has received fees to give talks for Boehringer Ingelheim, Casen Recordati, Lilly, Esteve, Exeltis, Janssen, Juste, Lundbeck, Otsuka, Pfizer, Rovi and Servier, she has received financial compensation for projects with Angelini, Lundbeck, Esteve, Pfizer, Rovi, Exeltis and Servier. she has received financial compensation for her participation as a board member of Janssen and Lundbeck, and she has received research funding from Acadia Pharmaceuticals, Eisai, Lundbeck, Novartis, Otsuka and Roche. All the other authors have no conflicts of interest.

Additional information

Funding

The Otsuka-Lundbeck alliance funded this work without participating in its design or data analysis. The Otsuka-Lundbeck alliance has reviewed the manuscript and suggested to add in the figures that tolerability to the drug should be tested before starting aripiprazole LAI and remarked that posology should comply with approved dosage regimens. All these suggestions were assessed by the authors and those included were accepted by all of them. This support was funded by the Otsuka-Lundbeck alliance.