Efficacy, safety both essential in choosing atypical antipsychotic treatments

A recent study of beliefs and preferences by psychiatrists and psychiatric pharmacists has found that efficacy and safety are equally important when choosing atypical antipsychotic treatments in patients with schizophrenia and bipolar disorders. In addition, they deem that formulary restrictions affect treatment choice and outcomes.

Members of the American College of Clinical Pharmacy and College of Psychiatric and Neurologic Pharmacists participated in this cross-sectional survey. The investigators assessed the participants’ beliefs regarding atypical antipsychotic effectiveness and safety, impact of comorbidity on drug selection, and factors influencing atypical antipsychotic therapy selection.

Of the participants who completed the survey, 18 were psychiatrists and 24 were psychiatric pharmacists. Their mean age was 39.6 years, and majority of them were women (57.1 percent). Most clinicians (64.3 percent) placed equal importance on medication effectiveness and safety, while 26.2 percent deemed safety and 9.4 percent believed effectiveness to be more essential.

Reducing positive symptoms (92.7 percent) and hospitalizations (87.8 percent) were the most important medication properties for schizophrenia; for bipolar disorder, these properties were reducing manic episodes (87.8 percent), episode relapse (53.7 percent), and hospitalizations (53.7 percent). In terms of adverse effects (AEs), the most alarming ones were agranulocytosis (78.1 percent), followed by arrhythmias (70.7 percent) and extrapyramidal AEs (68.3 percent).

Of note, restrictions appeared to have an impact on antipsychotic choice at 80.5 percent of sites and were deemed to affect medication adherence (55.0 percent) as well as outcomes (53.4 percent).

“Selection of schizophrenia or bipolar disorder treatments is complicated by treatment-effect heterogeneity,” the investigators noted.