Early Antipsychotic Nonresponse as a Predictor of Nonresponse and Nonremission in Adolescents With Psychosis Treated With Aripiprazole or Quetiapine: Results From the TEA Trial.

Abstract

OBJECTIVE:

To evaluate 1) whether early nonresponse to antipsychotics predicts nonresponse and nonremission, 2) patient and illness characteristics as outcome predictors, and 3) response prediction of 30-item Positive and Negative Syndrome Scale (PANSS-30) compared with 6-item PANSS (PANSS-6) and Clinical Global Impressions-Improvement Scale (CGI-I) in youths with first-episode psychosis.

METHOD:

Post hoc analysis from a 12-week, double-blinded, randomized trial of aripiprazole vs extended-release quetiapine in adolescents (age 12-17 years) with first-episode psychosis was performed. Early nonresponse (week 2 or week 4) was defined as <20% symptom reduction (PANSS-30) (or <20% symptom reduction [PANSS-6] or CGI-I score 4-7 [less than "minimally improved"]). Nonresponse (week 12) was defined as <50% symptom reduction (PANSS-30). Nonremission (week 12) was defined as a score of >3 on 8 selected PANSS-items. Positive/negative predictive values (PPV/NPV) and receiver operating characteristics, binary logistic regression models, and PPV/NPV using PANSS-6 and CGI-I were analyzed.

RESULTS:

Of 113 randomized patients, 84 were included in post hoc analysis (mean [SD] age = 15.7 [1.3] years; 28.6% male). The 12-week symptom decrease was 31.9% [27.9%], most pronounced within the first 2 weeks (61.1% of total PANSS reduction). Response (27.4%) and remission (22.6%) rates were low. Results indicated that early nonresponse reliably predicted 12-week nonresponse (PPV: week 2, 82.2%; week 4, 90.0%) and nonremission (PPV: week 2, 80.0%; week 4, 90.0%); early nonresponse at week 4 was a statistically significant baseline predictor for 12-week nonresponse; and PANSS-6 had similar predictive significance as PANSS-30. However, outcomes were heterogeneous using CGI-I.

CONCLUSION:

In youths with first-episode psychosis showing early nonresponse to aripiprazole or extended-release quetiapine, switching antipsychotic drug should be considered. PANSS-6 is a feasible and clinically relevant alternative to PANSS-30 to predict 12-week nonresponse/nonremission.

CLINICAL TRIAL REGISTRATION INFORMATION:

Tolerance and Effect of Antipsychotics in Children and Adolescents With Psychosis; https://www.

CLINICALTRIALS:

gov/; NCT01119014.

• Authors: Anne Katrine Pagsberg, Amanda Krogmann, Pia Jeppesen, Laura von Hardenberg, Dea G Klauber, Karsten Gjessing Jensen, Ditte Rudå, Marie Stentebjerg Decara, Jens Richardt Møllegaard Jepsen, Birgitte Fagerlund, Anders Fink-Jensen, Christoph U Correll, Britta Galling
• Journal: Journal of the American Academy of Child and Adolescent Psychiatry (J Am Acad Child Adolesc Psychiatry) Vol. 61 Issue 8 Pg. 997-1009 (08 2022) ISSN: 1527-5418 [Electronic] United States
• PMID: 35026408 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antipsychotic Agents
• Quetiapine Fumarate
• Aripiprazole

Topics

• Adolescent
• Antipsychotic Agents (pharmacology, therapeutic use)
• Aripiprazole (pharmacology)
• Child
• Double-Blind Method
• Female
• Humans
• Male
• Predictive Value of Tests
• Psychotic Disorders (drug therapy)
• Quetiapine Fumarate (therapeutic use)
• Treatment Outcome