Innovations In Clinical Neuroscience

MAR-APR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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13 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE March-April 2018 • Volume 15 • Number 3–4 subjects, while no statistical changes were found in the BPRS scores of the male subjects or in the DIEPSS scores in both sexes from baseline to the last observed points. The prolactin levels increased at one month and three months and decreased at 12 months in the female subjects; prolactin levels consistently decreased in male subjects, but not significantly. In male subjects on the 24mg dose, the prolactin levels significantly decreased at 12 months from baseline. The time-sequential changes of the values are presented in Table 1 and Figure 1. Discussion . The strength of our study demonstrates that switching to AOM is safe. The prolactin levels of our patients might correlate with D 2 receptor blockade suggested by previous studies. Administration of AOM 400mg has a pharmacokinetic profile consistent with that of oral doses of aripiprazole (10–30mg/day); 5 however, a steady state serum concentration is attained after the fourth injection based on approved label method. 6 The peak to trough fluctuation in serum concentration of aripiprazole is considered to be predominantly low, 7 and this dopamine partial agonist causes dose- dependent hypoprolactinemia in male subjects. 8 So, it is more likely that the prolactin levels are transiently elevated in female subjects and finally reduced or stabilized in all subjects. A comparative analysis from two placebo- controlled relapse prevention studies supported maintenance of effect and safety with PP compared with oral paliperidone extended release. 9 Also, a double-blind, randomized, noninferiority study reported that AOM 400mg was noninferior to oral aripiprazole 10mg or 30mg/day and had a safety profile comparable to that of oral aripiprazole. 10 In a meta-analysis of randomized, controlled studies comparing the same antipsychotics, it was demonstrated that LAIs and oral antipsychotics did not differ FIGURE 1. Changes in the levels of prolactin at baseline, 1, 3, 6, and 12 months after switching to aripiprazole once- monthly, divided by sex and previously treated oral aripiprazole daily dosage status TABLE 1. BPRS and DIEPSS total scores and serum prolactin levels for subjects with follow-up data OUTCOME MEASURE BASELINE 1 MONTH p 3 MONTHS p 6 MONTHS p 12 MONTHS p BPRS scores Male subjects 45.4±9.1 45.0±9.2 0.974 42.3±9.4 0.812 44.6±9.1 0.948 44.1±9.2 0.922 Female subjects 44.3±3.4 38.8±3.1 0.232 35.9±3.6 0.08 33.9±3.4 0.027 34.0±3.1 0.036 Combined 44.7±3.5 40.7±3.5 0.436 38.0±3.8 0.205 37.3±3.8 0.152 37.6±3.8 0.179 DIEPSS scores Male subjects 0.86±0.86 0.86±0.86 n/a 0.86±0.86 n/a 1.57±0.92 0.557 1.29±0.75 0.724 Female subjects 0.67±0.36 0.40±0.21 0.477 0.54±0.24 0.741 0.33±0.23 0.357 0.50±0.34 0.69 Combined 0.73±0.36 0.55±0.30 0.696 0.65±0.33 0.871 0.75±0.36 0.962 0.82±0.37 0.847 Prolactin levels, ng/dL Male subjects 3.21±0.85 2.64±0.62 0.526 2.44±0.52 0.379 1.92±0.59 0.169 1.58±0.50 0.087 Female subjects 7.12±0.95 9.02±2.31 0.461 9.50±2.60 0.356 7.30±1.70 0.945 5.05±1.30 0.446 Combined 5.52±0.77 6.33±1.53 0.641 6.32±1.63 0.64 5.31±1.24 0.904 3.53±0.86 0.277 Values are mean ± standard error unless otherwise specified. P values for intragroup comparisons for each time point relative to the baseline values with Fisher's protected least significant difference. Abbreviations: BPRS=18-item Brief Psychiatric Rating Scale, DIEPSS=9-item Drug-induced Extrapyramidal Symptoms Scale L E T T E R S T O T H E E D I T O R

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