Changes in psychopathology in schizophrenia patients starting treatment with new-generation antipsychotics: therapeutic drug monitoring in a naturalistic treatment setting

Abstract Previous studies on the relationship between plasma levels of new-generation antipsychotics (NGAs) and clinical response did not account for inter- and intra-individual variability in drug levels. Therefore, the present study calculated the ratio of observed versus expected NGA plasma level...

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Published in:	European neuropsychopharmacology Vol. 26; no. 4; pp. 717 - 728
Main Authors:	Kaufmann, Alexandra, Wartelsteiner, Fabienne, Yalcin-Siedentopf, Nursen, Baumgartner, Susanne, Biedermann, Falko, Edlinger, Monika, Kemmler, Georg, Rettenbacher, Maria A, Rissanen, Tanja T, Widschwendter, Christian G, Zernig, Gerald, Fleischhacker, W. Wolfgang, Hofer, Alex
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-04-2016
Subjects:	Adolescent Adult Aged Antipsychotic Agents - blood Antipsychotic Agents - pharmacokinetics Antipsychotic Agents - therapeutic use Antipsychotics Drug Monitoring Female Humans Internal Medicine Male Middle Aged Models, Biological Plasma level Psychiatric Status Rating Scales Psychiatry Ratio Schizophrenia Schizophrenia - blood Schizophrenia - drug therapy Schizophrenic Psychology Therapeutic drug monitoring Young Adult Therapeutic drug monitoring Schizophrenia Antipsychotics Ratio Plasma level
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Summary:	Abstract Previous studies on the relationship between plasma levels of new-generation antipsychotics (NGAs) and clinical response did not account for inter- and intra-individual variability in drug levels. Therefore, the present study calculated the ratio of observed versus expected NGA plasma levels and investigated its relationship with changes in the Positive and Negative Syndrome Scale (PANSS). Data of patients starting monotherapy with a NGA were collected 2, 4, 8, and 12 weeks after initiation of treatment. Next to the assessment of changes in psychopathology (PANSS) the ratio of observed versus expected plasma level was calculated. A total number of 221 ratios were eligible for analysis. About half of them ranged from 0.5–2 and were considered “normal”, whereas the others were considered either “too low” or “too high”. Psychopathological symptoms improved over the course of treatment, but changes in PANSS from baseline did not correlate significantly with the ratios of observed versus expected plasma levels at any assessment. The lack of linear correlation can be explained by the fact that 92% of the observed NGA plasma levels were at ≥50% of the lower limit of the therapeutic reference range, i.e., within the asymptote of the logistic plasma level-effect relationship. Accordingly, our findings indicate that the great majority of patients were treated with NGA doses that led to optimal plasma levels, based on the clinical impression of the treating psychiatrist only. Thus, calculating the ratio of observed versus expected plasma level may not be necessary in a routine clinical setting.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0924-977X 1873-7862
DOI:	10.1016/j.euroneuro.2016.02.002