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Cost effectiveness clozapine

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https://www.readbyqxmd.com/read/29695153/classics-in-chemical-neuroscience-risperidone
#1
Trevor C Chopko, Craig W Lindsley
After identifying the influence of serotonergic receptors in ameliorating the negative symptoms associated with schizophrenia, atypical antipsychotics were developed incorporating dopamine and serotonin antagonism. Risperidone, sold under the trade name Risperdal, was the second atypical antipsychotic developed following clozapine, but quickly became a first-line treatment for acute and chronic schizophrenia due to its preferential side effect profile. Despite initial FDA-approval 25 years ago, risperidone continues to be a fundamental treatment in schizophrenia, bipolar I disorder, and autism-related irritability...
April 25, 2018: ACS Chemical Neuroscience
https://www.readbyqxmd.com/read/29544555/implementing-national-institute-for-health-and-care-excellence-smoke-free-guidance-in-a-secure-facility-an-evaluation-of-the-prescribing-costs-in-clozapine-users
#2
Stephen Noblett, Jane Beenstock, James Noblett, Joanne Ireland, Sarah Ormiston
Aims and method The increased rates of smoking in people with mental illness is well documented, and establishing smoke-free mental health environments has been emphasised over recent years. This article examines the financial costs of implementing smoke free guidance and assesses the cost associated with patients who were prescribed clozapine and who committed to stopping smoking cigarettes for the duration of the study period. RESULTS: Patients (38) who were prescribed clozapine were included in the study...
April 2018: BJPsych Bulletin
https://www.readbyqxmd.com/read/29298994/cost-effectiveness-of-hla-dqb1-hla-b-pharmacogenetic-guided-treatment-and-blood-monitoring-in-us-patients-taking-clozapine
#3
François R Girardin, Antoine Poncet, Arnaud Perrier, Nathalie Vernaz, Mark Pletscher, Caroline F Samer, Jeffrey A Lieberman, Jean Villard
Less than 1% of adult patients with schizophrenia taking clozapine develop agranulocytosis, and most of these cases occur within the first weeks of treatment. The human leukocyte antigen (HLA) region has been associated with genetic susceptibility to clozapine-induced agranulocytosis (single amino acid changes in HLA-DQB1 (126Q) and HLA-B (158T)). The current study aimed to evaluate the cost-effectiveness, from a healthcare provider's perspective, of an HLA genotype-guided approach in patients with treatment-resistant schizophrenia who were taking clozapine and to compare the results with the current absolute neutrophil count monitoring (ANCM) schemes used in the USA...
January 3, 2018: Pharmacogenomics Journal
https://www.readbyqxmd.com/read/29036711/impacts-of-electroconvulsive-therapy-on-1-year-outcomes-in-patients-with-schizophrenia-a-controlled-population-based-mirror-image-study
#4
Hai-Ti Lin, Shi-Kai Liu, Ming H Hsieh, Yi-Ling Chien, I-Ming Chen, Shih-Cheng Liao, Hui-Ju Tsai, Chi-Shin Wu
Objectives: Despite the decline in the use of electroconvulsive therapy (ECT) in patients with schizophrenia, ECT augmentation is still recommended for those with poor response to standard pharmacological intervention. However, the effectiveness of augmentation of antipsychotics with ECT on long-term clinical outcomes needs to be verified in an expanded sample. Methods: Patients who were hospitalized for schizophrenia and received ECT for the first time during that hospitalization were identified from the total population health insurance database in Taiwan between 2002 and 2011...
September 23, 2017: Schizophrenia Bulletin
https://www.readbyqxmd.com/read/28869006/amisulpride-augmentation-in-clozapine-unresponsive-schizophrenia-amicus-a-double-blind-placebo-controlled-randomised-trial-of-clinical-effectiveness-and-cost-effectiveness
#5
Thomas Re Barnes, Verity C Leeson, Carol Paton, Louise Marston, Linda Davies, William Whittaker, David Osborn, Raj Kumar, Patrick Keown, Rameez Zafar, Khalid Iqbal, Vineet Singh, Pavel Fridrich, Zachary Fitzgerald, Hemant Bagalkote, Peter M Haddad, Mariwan Husni, Tim Amos
BACKGROUND: When treatment-refractory schizophrenia shows an insufficient response to a trial of clozapine, clinicians commonly add a second antipsychotic, despite the lack of robust evidence to justify this practice. OBJECTIVES: The main objectives of the study were to establish the clinical effectiveness and cost-effectiveness of augmentation of clozapine medication with a second antipsychotic, amisulpride, for the management of treatment-resistant schizophrenia...
September 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28808933/cardiovascular-disease-in-clozapine-treated-patients-evidence-mechanisms-and-management
#6
REVIEW
Kathlyn J Ronaldson
Myocarditis occurs in about 3% of those initiated on clozapine but monitoring reduces the risk of serious outcome. Cardiomyopathy may develop after myocarditis, or from prolonged tachycardia. Monitoring using echocardiography is not deemed cost effective. Tachycardia, orthostatic hypotension and reduced heart rate variability are a group of clozapine-related adverse effects associated with autonomic dysfunction and may have serious consequences in the long term. Elevated heart rate and poor heart rate variability can be treated with a β-blocker or a non-dihydropyridine calcium channel blocker, while orthostatic hypotension can be alleviated by increased fluid intake and abdominal binding, but may require pharmacological intervention...
September 2017: CNS Drugs
https://www.readbyqxmd.com/read/28613395/clozapine-dose-for-schizophrenia
#7
REVIEW
Selvizhi Subramanian, Birgit A Völlm, Nick Huband
BACKGROUND: Schizophrenia and related disorders such as schizophreniform and schizoaffective disorder are serious mental illnesses characterised by profound disruptions in thinking and speech, emotional processes, behaviour and sense of self. Clozapine is useful in the treatment of schizophrenia and related disorders, particularly when other antipsychotic medications have failed. It improves positive symptoms (such as delusions and hallucinations) and negative symptoms (such as withdrawal and poverty of speech)...
June 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28127934/antipsychotic-augmentation-vs-monotherapy-in-schizophrenia-systematic-review-meta-analysis-and-meta-regression-analysis
#8
Britta Galling, Alexandra Roldán, Katsuhiko Hagi, Liz Rietschel, Frozan Walyzada, Wei Zheng, Xiao-Lan Cao, Yu-Tao Xiang, Mathias Zink, John M Kane, Jimmi Nielsen, Stefan Leucht, Christoph U Correll
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=-0...
February 2017: World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
https://www.readbyqxmd.com/read/28119036/one-year-mirror-image-study-using-paliperidone-palmitate-for-relapse-prevention-of-schizophrenia-in-four-university-hospitals-in-canada
#9
Philippe D Vincent, Marie-France Demers, Venessa Doyon-Kemp, Josée Duchesneau, Alex Halme, Violaine Masson
BACKGROUND: Superiority of long acting injectable antipsychotics (LAI) over oral antipsychotics remains controversial and dependent on study design and inclusion criteria. Meta-analysis of 21 RCTs demonstrated no difference in their effectiveness, but meta-analysis of 25 mirror-image studies did. None of these included paliperidone palmitate (PP). METHODS: We challenged efficiency of PP in a multicentric mirror-image study. Primary outcome was total hospitalization days...
January 21, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28116777/pharmacological-treatment-for-antipsychotic-related-constipation
#10
REVIEW
Susanna Every-Palmer, Giles Newton-Howes, Mike J Clarke
BACKGROUND: Antipsychotic-related constipation is a common and serious adverse effect, especially for people taking clozapine. Clozapine has been shown to impede gastrointestinal motility, leading to constipation, and has been reported in up to 60% of patients receiving clozapine. In rare cases, complications can be fatal. Appropriate laxatives should be prescribed to treat constipation in people taking antipsychotics, but there is a lack of guidance on the comparative effectiveness and harms of different agents in this population...
January 24, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27977041/risperidone-versus-placebo-for-schizophrenia
#11
REVIEW
Ranganath D Rattehalli, Sai Zhao, Bao Guo Li, Mahesh B Jayaram, Jun Xia, Stephanie Sampson
BACKGROUND: Risperidone is the first new-generation antipsychotic drug made available in the market in its generic form. OBJECTIVES: To determine the clinical effects, safety and cost-effectiveness of risperidone compared with placebo for treating schizophrenia. SEARCH METHODS: On 19th October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials...
December 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27648956/withdrawn-risperidone-versus-other-atypical-antipsychotic-medication-for-schizophrenia
#12
REVIEW
Simon Gilbody, Anne-Marie Bagnall, Lorna Duggan, Arja Tuunainen
BACKGROUND: Risperidone is one of a number of 'atypical antipsychotics' which are currently being marketed for the treatment of those with schizophrenia, largely on the basis of claims of improved tolerability and effectiveness compared to much cheaper conventional antipsychotics. The efficacy of risperidone has already been compared to conventional drugs, but it remains unclear how risperidone compares with other atypical antipsychotic drugs such as clozapine. OBJECTIVES: To determine the effects of risperidone compared with other atypical antipsychotic drugs for schizophrenia...
September 20, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27629356/current-understanding-of-psychosis-in-parkinson-s-disease
#13
REVIEW
Oluwadamilola O Ojo, Hubert H Fernandez
Psychosis in Parkinson's disease (PD) is one of the greatest determinants of nursing home placement and caregiver stress. Traditionally associated with medications with dopaminergic effect, it has now been linked to other medications and other stressors e.g. systemic illnesses. The development of hallucinations in a PD patient can herald the onset of dementia and usually predicts increased mortality risk. Medication reduction in PD psychosis usually reduces the symptoms; however, this comes at the cost of worsening motor function...
October 2016: Current Psychiatry Reports
https://www.readbyqxmd.com/read/27496180/design-and-protocol-for-the-focusing-on-clozapine-unresponsive-symptoms-focus-trial-a-randomised-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Melissa Pyle, John Norrie, Matthias Schwannauer, David Kingdon, Andrew Gumley, Douglas Turkington, Rory Byrne, Suzy Syrett, Graeme MacLennan, Robert Dudley, Hamish J McLeod, Helen Griffiths, Samantha Bowe, Thomas R E Barnes, Paul French, Paul Hutton, Linda Davies, Anthony P Morrison
BACKGROUND: For around a third of people with a diagnosis of schizophrenia, the condition proves to respond poorly to treatment with many typical and atypical antipsychotics. This is commonly referred to as treatment-resistant schizophrenia. Clozapine is the only antipsychotic with convincing efficacy for people whose symptoms are considered treatment-resistant to antipsychotic medication. However, 30-40 % of such conditions will have an insufficient response to the drug. Cognitive behavioural therapy has been shown to be an effective treatment for schizophrenia when delivered in combination with antipsychotic medication, with several meta-analyses showing robust support for this approach...
August 5, 2016: BMC Psychiatry
https://www.readbyqxmd.com/read/27403276/risks-and-benefits-of-rapid-clozapine-titration
#15
Jeannie D Lochhead, Michele A Nelson, Alan L Schneider
Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration...
May 18, 2016: Mental Illness
https://www.readbyqxmd.com/read/27301766/the-business-case-for-expanded-clozapine-utilization
#16
Jessica L Gören, Adam J Rose, Eric G Smith, John P Ney
OBJECTIVE: In most settings, less than 25% of patients with treatment-resistant schizophrenia receive clozapine, the only medication proven effective for treatment-resistant schizophrenia. Therefore, a business case analysis was conducted to assess whether increasing clozapine utilization for treatment-resistant schizophrenia in a health care system would result in direct health care cost savings. METHODS: Veterans with treatment-resistant schizophrenia who were treated in the Veterans Health Administration (VHA) were studied...
November 1, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/27251620/decreasing-striatopallidal-pathway-function-enhances-motivation-by-energizing-the-initiation-of-goal-directed-action
#17
Fernanda Carvalho Poyraz, Eva Holzner, Matthew R Bailey, Jozsef Meszaros, Lindsay Kenney, Mazen A Kheirbek, Peter D Balsam, Christoph Kellendonk
UNLABELLED: Altered dopamine D2 receptor (D2R) binding in the striatum has been associated with abnormal motivation in neuropsychiatric disorders, including schizophrenia. Here, we tested whether motivational deficits observed in mice with upregulated D2Rs (D2R-OEdev mice) are reversed by decreasing function of the striatopallidal "no-go" pathway. To this end, we expressed the Gαi-coupled designer receptor hM4D in adult striatopallidal neurons and activated the receptor with clozapine-N-oxide (CNO)...
June 1, 2016: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/27132755/-cost-effectiveness-of-antipsychotics-in-the-maintenance-treatment-of-schizophrenia-in-colombia
#18
Hoover Quitian Reyes, Jair Alberto Arciniegas Barrera, Adriana Bohórquez Peñaranda, Carlos Gómez Restrepo
OBJECTIVE: Assess the cost-effectiveness of the antipsychotics for treatment of schizophrenia. METHODS: A five-year Markov model was built form patients with schizophrenia on the stage of maintenance. Costs were taken from the perspective of the Colombian health care system (Sistema General de Seguridad Social en Salud). The effectiveness was measured in years of life under the same maintenance plan. RESULTS: The Markov model indicated clozapine as the as the most cost-effective alternative between the first line antipsychotics and haloperidol is it when comparing other antipsychotics...
April 2016: Revista Colombiana de Psiquiatría
https://www.readbyqxmd.com/read/26784704/strong-treatment-response-and-high-maintenance-rates-of-clozapine-in-childhood-onset-schizophrenia
#19
RANDOMIZED CONTROLLED TRIAL
Lauren I Kasoff, Kwangmi Ahn, Peter Gochman, Diane D Broadnax, Judith L Rapoport
OBJECTIVE: Childhood-onset schizophrenia (COS) is a rare but severe form of the disorder, which is often treatment refractory. Short-term studies have indicated a greater differential efficacy, evident through effect sizes, favoring clozapine over other agents in alleviating negative symptoms in COS patients compared with adult-onset patients (AOS). There have been no data for COS patients on long-term compliance with clozapine treatment. Therefore, we wanted to know, over a span of up to 24 years, how many of our COS cohort had remained on clozapine for at least 2 years...
June 2016: Journal of Child and Adolescent Psychopharmacology
https://www.readbyqxmd.com/read/26406773/estimating-the-impact-of-adherence-to-and-persistence-with-atypical-antipsychotic-therapy-on-health-care-costs-and-risk-of-hospitalization
#20
Yawen Jiang, Weiyi Ni
STUDY OBJECTIVE: To estimate the impact of adherence to and persistence with atypical antipsychotics on health care costs and risk of hospitalization by controlling potential sources of endogeneity. DESIGN: Retrospective cohort study using medical and pharmacy claims data. DATA SOURCE: Humana health care insurance database. PATIENTS: A total of 32,374 patients with a diagnosis of schizophrenia or bipolar disorder and who had a prescription for noninjectable atypical antipsychotics (aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone), after a washout period of at least 180 days during which there was no use of any atypical antipsychotics, between January 2007 and June 2013...
September 2015: Pharmacotherapy
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