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Lack of Early Improvement with Antipsychotics is a Marker for Subsequent Nonresponse in Behavioral and Psychological Symptoms of Dementia: Analysis of CATIE-AD Data.


ABSTRACT: OBJECTIVE:Prediction of response or nonresponse to antipsychotics is especially important in patients with behavioral and psychological symptoms of dementia (BPSD) in whom antipsychotic exposure increases risks of death. This study examined whether the presence or absence of early improvement of BPSD with antipsychotics is associated with subsequent response or nonresponse. METHODS:In a post-hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) study (2001-2004) (clinicaltrials.gov; NCT00015548) in 45?U.S. sites, 245 subjects (olanzapine, N?=?90; quetiapine, N?=?81; risperidone, N?=?74) with a DSM-IV diagnosis of dementia of the Alzheimer type who presented with a score of 1 or more in the Brief Psychiatric Rating Scale (BPRS) at baseline (phase I of CATIE-AD) were randomly assigned to treatment with olanzapine, quetiapine, risperidone, or placebo in a double-blind manner. Associations were examined between response at week 8 and demographic and clinical characteristics, including BPRS total score reduction at week 2, using logistic regression analyses. Prediction performance of binary classification (presence or absence) of improvement or no improvement at week 2 for response at week 8 was examined. RESULTS:BPRS total score reduction at week 2 (mean percentage score reduction: 12.6%) was significantly associated with response at week 8 (odds ratio: 1.18; 95% CI: 1.11-1.26). The 5% score reduction cut-off at week 2 showed the highest accuracy (0.71), with sensitivity, specificity, and positive and negative predictivevalues of 0.76, 0.65, 0.69, and 0.72, respectively. CONCLUSION:Lack of even a very small early improvement with antipsychotic treatment may be a marker of subsequent nonresponse in BPSD.

SUBMITTER: Yoshida K 

PROVIDER: S-EPMC5474154 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Lack of Early Improvement with Antipsychotics is a Marker for Subsequent Nonresponse in Behavioral and Psychological Symptoms of Dementia: Analysis of CATIE-AD Data.

Yoshida Kazunari K   Roberts Rachel R   Suzuki Takefumi T   Lebowitz Barry B   Reeves Suzanne S   Howard Robert R   Abe Takayuki T   Mimura Masaru M   Uchida Hiroyuki H  

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20170130 7


<h4>Objective</h4>Prediction of response or nonresponse to antipsychotics is especially important in patients with behavioral and psychological symptoms of dementia (BPSD) in whom antipsychotic exposure increases risks of death. This study examined whether the presence or absence of early improvement of BPSD with antipsychotics is associated with subsequent response or nonresponse.<h4>Methods</h4>In a post-hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer'  ...[more]

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