Early predictors of poor treatment response in patients with schizophrenia treated with atypical antipsychotics

Yi-Lung Chen, Kun-Po Chen, Chih-Chiang Chiu, Ming-Hong Tai, For-Wey Lung, Yi-Lung Chen, Kun-Po Chen, Chih-Chiang Chiu, Ming-Hong Tai, For-Wey Lung

Abstract

Background: The aims of this study were to explore the relationship between early reduction in psychotic symptoms and the ultimate response in patients with schizophrenia treated by atypical antipsychotics, and to determine the best time to switch or maitain the regimen. We also explore the possible predictors for the clinical response.

Methods: One hundred eleven inpatients with acutely exacerbated schizophrenia were randomized to give optimal therapy of olanzapine, risperidone, and paliperidone in one-week run-in period and 12 weeks' intervention. All participants were assessed using Positive and Negative Syndrome Scale (PANSS). Early Response, defined as reduction of 25% in PANSS score, was examined at weeks 1, 2, 3, 4 and 8, and these ratings were used to predict ultimate response (25% PANSS reduction) at week 12. We hypothesized that early treatment response at Week 1 or 2 could predict Week 12's treatment outcome.

Results: The early treatment response at Week 2 had a greater negative prediction value (NPV, 93.6%) than did the response at Week 1 (NPV, 69.7%), Week 3 (NPV, 91.5%), Week 4 (NPV, 90.7%) and Week 8 (NPV, 87.2%). The positive predictive value became more acceptable (65%) until Week 4. There was no any other potential predictors, including types of antipsychotics medication and treatment dosage, were associated with ultimate response in this study.

Conclusion: The treatment non-response at Week 2 optimally predicted the ultimate (Week 12) non-response, in terms of negative predictive value (NPV). These finding suggests that the revision of treatment strategy should be considered t if patients with schizophrenia was not responsive to them after 2 weeks' treatment, and for those who are responders at Week 2, another two weeks are needed to further evaluate whether they will be continuously responsive.

Trial registration: NCT03730857 at ClinicalTrial.gov . Date of registration: 30/Oct/2018.

Keywords: Negative predictive value; PANSS; Positive predictive value; Schizophrenia.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Kaohsiung Armed Forces General Hospital, Taiwan. All participants provided written consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mean PANSS total scores change over time (PANSS: Positive and Negative Syndrome Scale)
Fig. 2
Fig. 2
ROC curves of the treatment response at Week 1, Week 2, Week 3, Week 4, and Week 8 for predicting the treatment response at Week 12, when defined as treatment response ⩾25% reduction of the PANSS total score from baseline. AUC: area under the curve; PANSS: Positive and Negative Syndrome Scale; ROC: receiver operating characteristic

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