2016, volume 32, issue 3

Review article

Long-acting aripiprazole in the treatment of schizophrenia; practical aspects

Marek Jarema, Adam Wichniak
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (3), 145–156

Treatment compliance is one of the most important factors in the course of antipsychotic therapy. Providing the fact that noncompliance or partial compliance with antipsychotic treatment is significant and may be found in even more than one half of patients, the use of long-acting injections of antipsychotics (LAI) becomes a more frequent form of treatment. The aim of the paper is to present the overview of studies indicating how the introduction of long-acting aripiprazole creates the new perspectives in antipsychotic treatment and how to initiate the treatment with this drug.
Aripiprazole is currently the only available antipsychotic drug showing partial agonism toward the D2 receptors. In clinical practice, this drug is characterised by lower propensity for extrapyramidal side-effects, sedation, weight gain, orthostatic hypotension, and cholinolytic symptoms in comparison to other antipsychotics. Aripiprazole LAI is indicated for maintenance treatment in adult patients with schizophrenia, who have been stabilised with oral aripiprazole treatment. The therapy with aripiprazole LAI should be initiated by injection of 400 mg and this dose should be repeated every month; this dose is considered the therapeutic one. After the first injection the oral supplementation with aripiprazole 10–20 mg/day for 14 days is needed.

Original article

Cost-effectiveness of aripiprazole once-monthly compared with LAI risperidone and LAI olanzapine

Katarzyna Kolasa, Izabela Lipka, Joanna Jakubiak-Lasocka, Maciej Niewada, Michał Jakubczyk, Jacek Wcislo, Adam Martyniuk, Zofia Wyszkowska
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (3), 157–169

Objectives. The aim of this study was to evaluate, in the Polish setting, the cost-effectiveness of aripiprazole once-monthly (Abilify Maintena®) in treating adults with schizophrenia, in the case of the recurrence of psychotic symptoms caused by a persistent and documented lack of compliance during antipsychotic oral therapy, in comparison with long acting injectable formulations of olanzapine and risperidone, which are currently refunded by the health system.

Material and methods. A decision-analytic Markov model was adopted. Both patients' compliance and the subsequent treatment switches were simulated. A10-year time horizon was assumed. The public payer perspective was adopted.

Results. The incremental cost-utility ratio (ICUR) of aripiprazole, given once-monthly, amounted to 70,777 PLN/QALY (quality-adjusted life year) and 57,649 PLN/QALY compared to risperidone and olanzapine LAI, respectively. Both ICURs were below the official threshold in Poland (119,577 PLN/QALY). The sensitivity analysis confirmed the robustness of the results. It included alternative values of discount rates, utility set, third line of treatment, dosage schemes and a different time horizon.

Conclusions. In the Polish setting aripiprazole, given once-monthly, is a cost-effective treatment option as compared with currently reimbursed atypical LAI antipsychotics. The results were robust irrespective of the discount rate and range of utility adopted. The cost effectiveness of aripiprazole given in this form was proven with different approaches taken towards the choice of third line options and time horizon of the treatment.

Review article

Antidepressive effect of botulinum neurotoxin injection

Marek Krzystanek, Roman Wojnar, Rafał Skowronek, Ewa Martyniak, Artur Pałasz
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (3), 171–180

The aim of this paper is to review the literature regarding a new method of the treatment of depression, in which a single dose of botulinum neurotoxin A is injected into the glabellar lines. The authors discuss the structure and mechanism of the effect of botulinum, along with the risk and symptoms of poisoning and the applications of botulinum in medicine. Five publications are reviewed, one of them involving a series of case studies and four reporting on clinical trials, in which botulinum A was administered to patients with moderate or severe depression. All trials demonstrate a significant antidepressive effect of botulinum A, injected in the glabellar region. This allows for the conclusion that botulinum A injection in the glabellar region is an effective and durable treatment for depression.

Review article

Long-term lithium treatment and the occurrence of renal tumors – literature review and case report

Maria Aleksandra Abramowicz, Katarzyna Jończyk-Potoczna, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (3), 181–191

Lithium, a mood-stabilizing drug, has been employed in psychiatry for nearly 70 years. Its use can result in an impairment of urine-concentrating ability and, with long-term administration, can lead to chronic tubular-interstitial nephropathy. Lithium induces cell proliferation in the kidneys, especially in the collecting ducts, resulting in tubular dilatation and the formation of cysts, as shown during imaging examinations in patients on long-term lithium treatment. In recent years, reports have appeared concerning an increased risk of renal tumors in lithium-treated patients with bipolar disorder (BD). The results of a study by French researchers published in 2014 suggested a manifold increased risk of kidney cancer in patients receiving long-term lithium treatment. The study was criticized and commented upon on by psychiatrists who have observed no such relationship in their clinical experience. In the last two years the results of three large population studies have been published (two performed in Denmark, one in Sweden); these have demonstrated that long-term lithium treatment is not connected with an increased risk of renal and upper urinary tract tumors. In this paper, the case of a 56-year female BD patient is reported. She has been receiving lithium for more than 10 years, during which time (2011) an ultrasonographic examination detected a tumor of 5×5×4.5 cm in her left kidney. Normal indices of kidney function suggested that the tumor was not associated with the lithium treatment. The tumor was surgically removed without necessity of further treatment. Histopathological examination pointed to carcinoma papillare. The patient has continued with the lithium treatment since the removal of the tumor, to good effect.

Scientific conference report

Report on the 8th ECNP School of Neuropsychopharmacology, 26 June – 1 July 2016, Oxford

Przemysław Sieracki
Farmakoterapia w Psychiatrii i Neurologii 2016, 32 (3), 193–196

The ECNP School has been organized to provide highlevel training in neuropsychopharmacology to young physicians and scientists from all over Europe. The School attracts a faculty of international experts. The aim of this report is to summarize the training which took place in Oxford between 26 June and 1 July 2016. It presents the topics of lectures and events that accompanied this meeting as well as the most important conclusions.