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Early Response to Antipsychotics Predicts Subsequent Response: Presented at ECNP By Paula Moyer VIENNA, AUSTRIA -- October 19, 2007 -- Patients with schizophrenia who have an early response to antipsychotic therapy are more likely to continue to respond than those who initially do not respond, according to investigators who presented the results here at the 20th European College of Neuropsychopharmacology (ECNP) Congress. "Early nonresponders attained significantly less overall improvement in symptoms compared to those patients who showed an early response," said principal investigator Bruce J. Kinon, MD, Neurosciences Medical Advisor, Eli Lilly and Company, Indianapolis, Indiana, United States. "The shorter time to discontinuation and higher discontinuation rates for patients in the early-nonresponder group suggest a greater risk for poor outcomes," he added. Dr. Kinon and colleagues conducted the study because earlier research had suggested that an early response to antipsychotic therapy, as early as 2 weeks, could accurately predict a subsequent response. Therefore, they conducted a post hoc analysis that assessed the predictive accuracy of responder status 2 weeks after the start of therapy to responder status after 6 months of therapy, as well as the clinical ramifications of patients' early responder status. The investigative team used data from five randomised, double-blind clinical trials comparing olanzapine with other atypical antipsychotic drugs in the treatment of 1,077 patients with schizophrenia, schizoaffective, or schizophreniform disorder. Early response was defined as an improvement of at least 20% on the Positive and Negative Syndrome Scales (PANSS) total score 2 weeks after beginning treatment. A subsequent response was defined as a reduction of at least 40% in the PANSS total score from baseline. The investigators then compared the likelihood of being a responder at 6 months among the 325 early responders (30%) and the 752 early nonresponders (70%). They also compared the reductions in PANSS total scores from baseline in the two groups. Rates of early study discontinuation and time to all-cause treatment discontinuation based on early responder status were also compared, as well as the rate of normal to mild severity of symptoms on the Clinical Global Impressions - Severity (CGI-S) scale (Fisher's exact test). Among early nonresponders, 19% were responders at 6 months compared with 52% of early responders (P <.001). At endpoint, 79% of nonresponders had been correctly identified as nonresponders 2 weeks after the start of treatment. Compared with early responders, early nonresponders achieved significantly less improvement in PANSS total score at all subsequent points of the study (P <.001). Similarly, 39% of early nonresponders had CGI-S ratings of normal to mildly ill at endpoint, compared with 66% of early responders (P <.001). Nonresponders also had a shorter time to discontinuation of treatment for any reason (P <.001); 52% of them discontinued treatment early compared with 37% of early responders (P <.001). Therefore, the investigators concluded that early nonresponders could benefit from a change in their antipsychotic regimen rather than have prolonged exposure to suboptimal or ineffective treatment. Funding for this study was provided by Eli Lilly and Company. [Presentation title: Antipsychotic Effectiveness Based on Early Response in the Treatment of Schizophrenia. Abstract P.3.c.040] E-mail this page to a friend or colleague! To print, use this version