Early response predicts subsequent response to olanzapine long-acting injection in a randomized, double-blind clinical trial of treatment for schizophrenia

• Published in: BMC psychiatry 2011-09, Vol.11 (1), p.152-152, Article 152
• Main Authors: Ascher-Svanum, Haya, Zhao, Fangyi, Detke, Holland C, Nyhuis, Allen W, Lawson, Anthony H, Stauffer, Virginia L, Montgomery, William, Witte, Michael M, McDonnell, David P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - therapeutic use; Benzodiazepines - administration & dosage; Benzodiazepines - therapeutic use; Delayed-Action Preparations - therapeutic use; Drug therapy; Female; Health aspects; Humans; Injections, Intramuscular; Male; Middle Aged; Olanzapine; Predictive Value of Tests; Psychiatric patients; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Psychotropic drugs; Schizophrenia; Schizophrenia - drug therapy; Sensitivity and Specificity; Time Factors
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/1471-244X-11-152

In patients with schizophrenia, early non-response to oral antipsychotic therapy robustly predicts subsequent non-response to continued treatment with the same medication. This study assessed whether early response predicted later response when using a long-acting injection (LAI) antipsychotic. Data were taken from an 8-week, randomized, double-blind, placebo-controlled study of olanzapine LAI in acutely ill patients with schizophrenia (n = 233). Early response was defined as ≥ 30% improvement from baseline to Week 4 in Positive and Negative Syndrome Scale (PANSS0-6) Total score. Subsequent response was defined as ≥ 40% baseline-to-endpoint improvement in PANSS0-6 Total score. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy were calculated. Clinical and functional outcomes were compared between Early Responders and Early Non-responders. Early response/non-response to olanzapine LAI predicted later response/non-response with high sensitivity (85%), specificity (72%), PPV (78%), NPV (80%), and overall accuracy (79%). Compared to Early Non-responders, Early Responders had significantly greater improvement in PANSS0-6 Total scores at all time points and greater baseline-to-endpoint improvement in PANSS subscale scores, Quality of Life Scale scores, and Short Form-36 Health Survey scores (all p ≤ .01). Among Early Non-responders, 20% demonstrated response by Week 8. Patients who lacked early improvement (at Week 4) in Negative Symptoms and Disorganized Thoughts were more likely to continue being non-responders at Week 8. Among acutely ill patients with schizophrenia, early response predicted subsequent response to olanzapine LAI. Early Responders experienced significantly better clinical and functional outcomes than Early Non-responders. Findings are consistent with previous research on oral antipsychotics. F1D-MC-HGJZ: Comparison of Intramuscular Olanzapine Depot With Placebo in the Treatment of Patients With Schizophrenia http://clinicaltrials.gov/ct2/show/NCT00088478?term=olanzapine+depot&rank=3Registry identifier - NCT00088478.