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Plasma levels and estimated dopamine D2 receptor occupancy of long-acting injectable risperidone during maintenance treatment of schizophrenia: a 3-year follow-up study

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Abstract

Introduction

Dopamine D2 receptor occupancy levels needed for the maintenance treatment of schizophrenia remain to be elucidated. We examined 3-year clinical outcomes of patients with schizophrenia who received long-acting injectable risperidone (LAI risperidone) at baseline and investigated their dopamine D2 receptor occupancy levels, estimated from plasma drug concentrations.

Methods

A chart review of 52 outpatients with schizophrenia who participated in the original cross-sectional study was conducted to examine their 3-year clinical outcomes between April and September 2015. Patients who continued outpatient treatment with LAI risperidone without any usage of concomitant chlorpromazine equivalent antipsychotic dosage at >200 mg/day for the 3-year period were asked to participate in the follow-up assessments that included the Brief Psychiatric Rating Scale (BPRS) and estimated dopamine D2 receptor occupancy levels at trough, using plasma concentrations of risperidone plus 9-hydroxyrisperidone. Data were compared with the same patients collected 3 years earlier.

Results

Among the original 52 participants, 14 participants (27 %) continued outpatient treatment with LAI risperidone. Ten participants (19 %) provided plasma samples; mean ± SD measured trough concentration of risperidone plus 9-hydroxyrisperidone significantly increased from 22.9 ± 15.6 to 31.8 ± 17.5 ng/mL (P = 0.02). Estimated dopamine D2 receptor occupancy numerically increased from 63.0 ± 10.9 to 69.0 ± 11.0 % (P = 0.12). A significant worsening was observed in the BPRS total score among these patients (mean ± SD, 34.3 ± 12.7 to 46.5 ± 16.9, P = 0.003).

Conclusion

Paradoxically, the increased plasma concentration was found to be associated with a significant worsening of the clinical outcome. More investigations are indicated to shed further light on optimal levels of D2 blockade in the maintenance treatment of schizophrenia.

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Acknowledgments

The authors thank Drs. Norifusa Sawada, Ryosuke Den, Kenichi Tsunoda, and Tatsuya Ishigaki and Ms. Aki Endo, and Ms. Ai Otani for their administrative support.

Contributors

Drs. Ikai and Uchida contributed to and have approved the design and the protocol of the study and the literature searches. Drs. Ikai and Uchida undertook the statistical analysis. Drs. Ikai and Uchida wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

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Authors and Affiliations

  1. Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Saeko Ikai, Takefumi Suzuki, Masaru Mimura & Hiroyuki Uchida

  2. Department of Psychiatry, Inokashira Hospital, 4-14-1, Kamirenjaku, Mitaka, Tokyo, 181-0012, Japan

    Takefumi Suzuki

  3. Geriatric Mental Health Program, Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada

    Hiroyuki Uchida

Authors
  1. Saeko Ikai
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  2. Takefumi Suzuki
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  4. Hiroyuki Uchida
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Corresponding author

Correspondence to Hiroyuki Uchida.

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Conflict of interests

Dr. Ikai has received manuscript fees or speaker’s honoraria from Dainippon-Sumitomo and Otsuka within the past 3 years. Dr. Suzuki has received manuscript or speaker’s honoraria from Astellas, Dainippon-Sumitomo, Eli Lilly, Elsevier Japan, Janssen, Meiji-Seika, Novartis, Otsuka, and Weily Japan within the past 3 years. Dr. Mimura has received grants and/or speaker’s honoraria from Asahi Kasei Pharma, Astellas Pharmaceutical, Daiichi Sankyo, Dainippon-Sumitomo Pharma, Eisai, Eli Lilly, Fuji Film RI Pharma, Janssen Pharmaceutical, Kracie, Meiji-Seika Pharma, Mochida Pharmaceutical, MSD, Novartis Pharma, Ono Yakuhin, Otsuka Pharmaceutical, Pfizer, Shionogi, Takeda Yakuhin, Tanabe Mitsubishi Pharma, and Yoshitomi Yakuhin within the past 3 years. Dr. Uchida has received grants from Astellas Pharmaceutical, Eisai, Otsuka Pharmaceutical, Shionogi, Dainippon-Sumitomo Pharma, Eli Lilly, Mochida Pharmaceutical, Meiji-Seika Pharma, and Yoshitomi Yakuhin and speaker’s honoraria from Otsuka Pharmaceutical, Eli Lilly, Shionogi, Pfizer, Yoshitomi Yakuhin, Dainippon-Sumitomo Pharma, Meiji-Seika Pharma, MSD, and Janssen Pharmaceutical within the past 3 years.

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Ikai, S., Suzuki, T., Mimura, M. et al. Plasma levels and estimated dopamine D2 receptor occupancy of long-acting injectable risperidone during maintenance treatment of schizophrenia: a 3-year follow-up study. Psychopharmacology 233, 4003–4010 (2016). https://doi.org/10.1007/s00213-016-4428-1

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