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Extended release (XR) and immediate release (IR) quetiapine have differing dosing, titration and plasma concentration profiles. The authors assessed whether the use of quetiapine XR and IR in schizophrenia spectrum disorders (SCZ) and bipolar disorder (BD) differ.
Retrospective non-interventional registry study.
Secondary healthcare.
All SCZ and BD...
Context in source publication
Context 1
... half (48.3%) of the patients in the IR group were using quetiapine in daily doses #200 mg, whereas such low doses were observed in only 2.3% of the patients in the XR group (table 3). Consequently, there was a statistically significant difference in the use of quetiapine doses $400 mg/day during the inpatient stay between the XR and IR groups: 65.1% of patients in the XR group and 39.7% of patients in the IR group (p¼0.011). ...
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Citations
... Psychiatric patients often face financial difficulties due to their chronic psychiatric conditions and inability to sustain a long-term full-time job. On the other hand, there are many generic forms of immediate release of Quetiapine that are available, which are affordable (Hallinen et al., 2012). ...
Quetiapine is a second-generation antipsychotic that is most favoured for its low propensity for extrapyramidal side effects. However, Quetiapine requires slow titration, which is disadvantageous. The brief review discussed research that trialled rapid titration of Quetiapine The author searched PubMed, Proquest, Embase, Google Scholar and Google Web using the keyword 'rapid titration' and 'quetiapine'. A total of 18 articles were included. The process, safety and efficacy of rapid titration of Quetiapine was examined. In conclusion, preliminary results appear to show that there is minimal difference in efficacy, between the rapid and traditional titration of Quetiapine. Sedation tended to occur more frequently and earlier among experimental group, and this might render rapid titration of Quetiapine to be suitable for agitated patients. There is a need for more large-scale, multisite, randomized clinical trials to examine the safety and efficacy of rapid titration of Quetiapine.
... This is achieved through the delayed release of the XL formulation, which allows plasma drug concentrations to be maintained at constant levels for a longer time period [6]. Faster dose titration and a different pharmacological and tolerability profile have been shown with quetiapine XL in comparison to the immediate release formulation [5,7]. ...
Background:
A post-authorisation safety study was carried out as part of the EU Risk Management Plan to examine the long-term (up to 12 months) use of quetiapine XL as prescribed in general practice in England.
Aim:
To present a description of the drug utilisation characteristics of quetiapine XL.
Methods:
An observational, population-based cohort design using the technique of Modified Prescription-Event Monitoring (M-PEM). Patients were identified from dispensed prescriptions issued by general practitioners (GPs) for quetiapine XL between September 2008 and February 2013. Questionnaires were sent to GPs 12 months following the 1st prescription for each individual patient, requesting drug utilisation information. Cohort accrual was extended to recruit additional elderly patients (special population of interest). Summary descriptive statistics were calculated.
Results:
The final M-PEM cohort consisted of 13,276 patients; median age 43 years (IQR: 33, 55) and 59.0% females. Indications for prescribing included bipolar disorder (n=3820), MDD (n=2844), schizophrenia (n=2373) and other (non-licensed) indications (n=3750). Where specified, 59.3% (7869/13,276) were reported to have used quetiapine IR (immediate release formulation) previously at any time. The median start dose was highest for patients with schizophrenia (300mg/day [IQR 150, 450]). The final elderly cohort consisted of 3127 patients and 28.5% had indications associated with dementia. The median start dose for elderly patients was highest for patients with schizophrenia or BD (both 100mg/day [IQR 50, 300]).
Conclusions:
The prevalence of off-label prescribing in terms of indication and high doses was common, as was use in special populations such as the very elderly. Whilst off-label use may be unavoidable in certain situations, GPs may need to re-evaluate prescribing in circumstances where there may be safety concerns. This study demonstrates the ongoing importance of observational studies such as M-PEM to gather real-world clinical data to support the post-marketing benefit:risk management of new medications, or existing medications for which license extensions have been approved.
... Little, however, is known about the relative use of quetiapine XR/IR in real-life treatment of patients with BD, although a recent naturalistic study showed differential use of the two formulations in a small subgroup of patients with BD [Hallinen et al. 2012]. The aim of this epidemiological registry study in Sweden was to ascertain whether there were also differences in clinical practice as regards treatment patterns and patient characteristics for BD patients treated with quetiapine IR continuously compared with those who were switched to quetiapine XR. ...
... The observed use of higher daily quetiapine dosages is supported by previous reports and suggests more psychiatrically burdened patients. For example, recent findings in patients with schizophrenia and BD showed that quetiapine XR was more often used as monotherapy and in significantly higher doses than quetiapine IR [Hallinen et al. 2012]. Similar findings have been suggested in other studies in patients with schizophrenia, where quetiapine IR was used at lower doses as as-needed medication for its sedative and/or anxiolytic effects, whilst quetiapine XR was used at higher doses for its antipsychotic effect [Emborg et al. 2012;Eriksson et al. 2012]. ...
Objectives:
The objective of this work was to study characteristics and clinical treatment patterns of bipolar disorder (BD) patients admitted to hospital and treated with quetiapine (immediate-release [IR] or extended-release [XR] formulations).
Methods:
BD patients admitted to hospital and prescribed quetiapine IR were followed by linking two Swedish nationwide registries; the hospitalization and drug dispense registries [ClinicalTrials.gov identifier: NCT01455961]. The study period was from 1 January 2008, to end of 31 December 2011. Data was primarily analysed using descriptive methods.
Results:
Quetiapine IR was used in 1761 patients of whom 1303 subsequently switched to XR (switch XR) and 458 remained on IR (continuous IR). At baseline, Switch XR patients were younger (-3.3 years), more frequently employed (+7.1%), had higher prevalence of single depressive episodes (+6.7%) and anxiety disorders (+5.8%), lower mean daily IR dose (-19.3%) and fewer medications for somatic disorders (-7.5%) than continuous IR patients. During follow up, the number of concomitant psychiatric medications was lower in switch XR patients (-6%) and higher in continuous IR patients (+6%). Mean daily quetiapine dose was 21% higher in switch XR versus continuous IR patients. Prescriptions of lower quetiapine dosages calculated below 50 mg per day in the XR switch and IR continuous groups were seen in 8% versus 10% of the patients, respectively.
Conclusions:
Differential use of quetiapine XR and IR in bipolar disorder patients with different and important characteristics was demonstrated. Patients who were switched to quetiapine XR had a higher psychiatric disease burden, were younger and had a higher degree of employment. These differences demonstrate the heterogeneity among bipolar disorder patients and indicate the need in clinical practice for individualized treatment to reduce the risk for both patient and society related losses.
... Individualized long-term treatment is crucial to achieve treatment success, to avoid side effects and to increase patient compliance (13,14). Atypical antipsychotics have recently been proven to be of use both as monotherapy and in combination with other psychopharmacological treatment options (15)(16)(17)(18)(19)(20)(21). ...
Objectives:
The aim of the study was to describe temporal changes in bipolar disorder during 20 years within the Swedish population and to investigate clinical and socioeconomic characteristics, drug treatment, and mortality among patients with bipolar disorder.
Methods:
We conducted a retrospective, nationwide registry study (the Swedish Population Register) that included all patients diagnosed with bipolar disorder (1991-2010) and linked individual data from the Swedish National Patient Register, the National Prescribed Drug Register, and the Population Register (NCT01455961). A cross-sectional cohort analysis was performed for years 2006 versus 2009. Data were analyzed using descriptive statistics.
Results:
During the study period, the annual incidence of diagnosed bipolar disorder increased 3.5-fold, and patients were diagnosed at a younger age. Mortality among patients with bipolar disorder was twice that of the general population. Compared to an age-standardized population, 30% fewer patients with bipolar disorder were available for work. Among the 40% employed, 64% reported sick leave (46% >100 days/year). Despite similar education levels, disposable income was lower compared to the general population. The most commonly preceding psychiatric diagnoses were depressive or anxiety disorders. Comparing the data for 2006 and 2009 demonstrated similar somatic comorbidity burdens and socioeconomic levels. There was also a decrease in dispensed antipsychotic medications and lithium, while antiepileptic prescriptions increased slightly. Antidepressant dispenses remained virtually unchanged.
Conclusions:
In Sweden, the incidence and prevalence of diagnosed bipolar disorder have increased during the last 20 years. Compared to the general population, these patients had similar education levels, lower employment levels, less disposable income, more sick leave, and twice the mortality. A trend towards earlier diagnosis, more use of antidepressants, and less use of lithium was seen.
Antipsychotic treatment choice in first‐episode psychosis is multifaceted with a need to focus on all aspects of recovery. There are clear differences between quetiapine immediaterelease (IR) and modified‐release (MR) that may have clinical significance in this patient group.
The aim of this hypothesis-generating pilot study was to assess prospectively the objective and subjective effects of treatment with quetiapine XR on sleep during early recovery from alcohol dependence (AD).
Recovering subjects with AD and sleep disturbance complaints were treated with quetiapine XR (n = 10) or matching placebo pills (n = 10) for 8 weeks. Polysomnography was used to assess sleep objectively, and the Insomnia Severity Index and Pittsburgh Sleep Quality Index were used to measure subjective insomnia. Other assessment measures included the 10-minute psychomotor vigilance task (for neurobehavioral functioning), the time-line follow-back measure (for alcohol consumption), the Penn Alcohol Craving Scale (for alcohol craving), the Patient Health Questionnaire-9 item scale (for depressive symptoms), and the Beck Anxiety Inventory (for anxiety symptoms).
Although there was no effect of quetiapine XR on sleep efficiency (time spent asleep/total recording time), there was a pre-to-post reduction in wake after sleep onset time (P = 0.03) and nonsignificant trends for increases in sleep onset latency (SOL) and stage 2 sleep time. A time × drug interaction was seen for the subjective insomnia, such that quetiapine XR-treated subjects reported greater initial improvement in their subjective insomnia, but the difference was not sustained. There were no differences between treatment groups on other measures or medication compliance.
Quetiapine XR improves objective sleep continuity and transiently improves subjective insomnia early in recovery from AD.
Differences in treatment patterns, health care resource use, and costs are expected among patients newly treated with quetiapine extended release (XR) or quetiapine immediate release (IR).
To compare treatment patterns, health care resource use, and costs in patients with bipolar disorder newly treated with quetiapine XR or quetiapine IR.
This was an observational, retrospective cohort study that used HealthCore Integrated Research Database-identified patients (age range, 18-64 years) with an International Classification of Disease, Ninth Revision diagnosis of bipolar disorder and ≥1 pharmacy claim for quetiapine XR or quetiapine IR between October 2, 2008, and July 31, 2010. Outcomes were as follows: patient characteristics at the index date (first claim for quetiapine XR or quetiapine IR); 12-month preindex clinical characteristics, health care resource use, and costs; and 12-month postindex treatment patterns, health care resource use, and costs, assessed using generalized linear models (adjusted for index date and preindex patient demographic characteristics, clinical characteristics, health care resource use, and costs).
In total, 3049 patients with bipolar disorder were analyzed (651 in the quetiapine XR group and 2398 in the quetiapine IR group). Of patients initiating treatment with quetiapine XR, 8.8% had no change in or discontinuation of their index therapy compared with 5.7% of patients treated with quetiapine IR (adjusted odds ratio, 1.44; 95% confidence interval, 1.03-2.00; P = 0.0317). The average daily dose (adjusted mean) of quetiapine XR was higher than quetiapine IR (225 vs 175 mg/d, P < 0.0001). An average daily dose of 300 to 800 mg was reached sooner (15.6 vs 30.8 days, P = 0.0049) and in more patients (44.2% vs 27.2%, P < 0.0001) who were taking quetiapine XR compared with patients taking quetiapine IR. No differences in total health care costs were found between the cohorts; however, patients taking quetiapine XR were less likely to be hospitalized for mental health-related reasons (12.1% vs 18.3%, P = 0.0022) and incurred lower mental health-related costs (US $6686 vs US $7577, P = 0.0063) compared with patients taking quetiapine IR.
Treatment patterns and dosing differ in patients with bipolar disorder treated with quetiapine XR compared with those treated with quetiapine IR. Mental health-related hospitalizations and costs may be reduced in the 12 months after patients initiating treatment with quetiapine XR compared with initiating treatment with quetiapine IR.
