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

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

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 score ≤3 (mild) 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.

OriginalsprogEngelsk
TidsskriftJournal of the American Academy of Child and Adolescent Psychiatry
Vol/bind61
Udgave nummer8
Sider (fra-til)997-1009
ISSN0890-8567
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
Funds totaling DKK 18,703,207 (USD 2,704,261) were provided by the following public and private funds: National Research Council for Health and Disease Foundation for Health Promotion (DKK 293,722); AP M?ller Foundation (DKK 50,000); Rosalie Petersens Foundation (DKK 60,000); Stevn and Rindom Foundation (DKK 50,000); Foundation for the Promotion of Medical Science (DKK 66,000; 50,000); Capital Region Psychiatric Research Foundation (DKK 1,530,000; 880,000; 2,475,000; 67,000; 120,000; 1,521,667); Tryg Foundation (DKK 5,558,703); Region of Southern Denmark Research Foundation (DKK 1,410,900); Danish Psychiatric Research Educational Fund (DKK 150,000); Psychiatry Foundation (DKK 1,000,000); Foundation of 17-12-1981 (DKK 600,000); Psychiatric Research Foundation Region Zealand (DKK 100,000; 250,000); Capital Region Strategic Research Foundation (DKK 800,000); Knud og Dagny Andresens Foundation (DKK 100,000); Psychiatric Research Foundation of 1967 (DKK 40,000); Capital Region Research Foundation (DKK 180,000); Dr. Sofus Carl Emil Friis and Hustru Olga Friis Scholarship (DKK 722,215); T?mrerhandler Johannes Fogs Foundation (DKK 25,000); Brdr Hartmanns Foundation (DKK 150,000); Aase and Ejnar Danielsens Foundation (DKK 100,000); Jacob Madsen and wife Olga Madsens Foundation (DKK 10,000); CC Klestrup and wife Scholarship (DKK 20,000); Lundbeck Foundation Scholarship (DKK 140,000); and T?mrermester J?rgen Holm and wife Elisas Scholarship (DKK 183,000).

Funding Information:
Funds totaling DKK 18,703,207 (USD 2,704,261) were provided by the following public and private funds: National Research Council for Health and Disease Foundation for Health Promotion (DKK 293,722); AP Møller Foundation (DKK 50,000); Rosalie Petersens Foundation (DKK 60,000); Stevn and Rindom Foundation (DKK 50,000); Foundation for the Promotion of Medical Science (DKK 66,000; 50,000); Capital Region Psychiatric Research Foundation (DKK 1,530,000; 880,000; 2,475,000; 67,000; 120,000; 1,521,667); Tryg Foundation (DKK 5,558,703); Region of Southern Denmark Research Foundation (DKK 1,410,900); Danish Psychiatric Research Educational Fund (DKK 150,000); Psychiatry Foundation (DKK 1,000,000); Foundation of 17-12-1981 (DKK 600,000); Psychiatric Research Foundation Region Zealand (DKK 100,000; 250,000); Capital Region Strategic Research Foundation (DKK 800,000); Knud og Dagny Andresens Foundation (DKK 100,000); Psychiatric Research Foundation of 1967 (DKK 40,000); Capital Region Research Foundation (DKK 180,000); Dr. Sofus Carl Emil Friis and Hustru Olga Friis Scholarship (DKK 722,215); Tømrerhandler Johannes Fogs Foundation (DKK 25,000); Brdr Hartmanns Foundation (DKK 150,000); Aase and Ejnar Danielsens Foundation (DKK 100,000); Jacob Madsen and wife Olga Madsens Foundation (DKK 10,000); CC Klestrup and wife Scholarship (DKK 20,000); Lundbeck Foundation Scholarship (DKK 140,000); and Tømrermester Jørgen Holm and wife Elisas Scholarship (DKK 183,000).

Publisher Copyright:
© 2022 American Academy of Child and Adolescent Psychiatry

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