A randomized trial of paliperidone palmitate and risperidone long-acting injectable in schizophrenia

作者：Fleischhacker W Wolfgang^*; Gopal Srihari; Lane Rosanne; Gassmann Mayer Cristiana; Lim Pilar; Hough David; Remmerie Bart; Eerdekens Marielle

来源：International Journal of Neuropsychopharmacology, 2012, 15(1): 107-118.

DOI：10.1017/S1461145711001076

• Atypical antipsychotic
• efficacy
• intramuscular
• long-acting injectables
• paliperidone palmitate
• risperidone
• schizophrenia
• second-generation antipsychotics

Paliperidone palmitate (PP) is a recently (USA) approved injectable new-generation antipsychotic. This 53-wk, Phase-III double-blind study was designed to assess the non-inferiority of PP to risperidone long-acting injectable (RIS-LAI) in schizophrenia treatment. Acutely symptomatic patients (n = 749), with a Positive and Negative Syndrome Scale (PANSS) total score between 60 and 120 were randomly allocated to gluteal injections of either (a) PP: 50 mg eq. on days 1 and 8, and flexible dosing [25-100 mg eq. (i.e. 39-156 mg USA dosing)] once-monthly; or (b) RIS-LAI: bi-weekly injections of 25 mg on days 8 and 22, and flexible dosing (25-50 mg) starting from day 36, with allowed oral supplementation. Patients (n = 747) were 59% men, 92% To white, mean (S.D.) age of 41 (11.95) yr and 45% (n = 339) completed the study. Mean (S.D.) change from baseline to endpoint in PANSS total score was: -11.6 (21.22) PP; and -14.4 (19.76) RIS-LAI (per-protocol analysis set, primary measure); least-squares means difference was -2.6 (95% CI -5.84 to 0.61), with a prespecified 5-point non-inferiority margin. PP%26apos;s suboptimal dosing regimen (%26lt;150 mg eq. initial dose) resulted in lower median plasma levels of the active moiety in PP-treated vs. RIS-LAI-treated patients. Insomnia was the most common treatment-emergent adverse event, with a similar incidence in both groups (15%). PP did not demonstrate comparable efficacy to RIS-LAI, which may be attributable to the initiation dosing strategy employed. Tolerability of both treatments was comparable to previous studies, with no new safety signals detected.

• 出版日期2012-2