Bipolar Disorder Relapse Episodes Delayed With Risperidone Treatment

A study was conducted in Taiwan to determine whether risperidone long-acting injection (RLAI) would be a long-lasting and cost-effective treatment in patients with bipolar disorder (BD), according to a study reported in Journal of Affective Disorders.

In the study, RLAI, an antipsychotic, was administered along with monotherapy or adjunctive therapy to combat the length of time to relapse in mood episodes. Relapses are extremely prevalent in patients with BD and create an escalation of total cost for extensive treatments and visits to healthcare facilities.

Researchers from the department of psychiatry, National Taiwan University Hospital, Taipei, conducted a study consisting of 287 patients with BD who received 25 to 50 mg of RLAI plus treatment for a 52-week duration double-blind placebo-controlled study. The two study groups were patients with rapid cycling and non-rapid cycling BD.

Rapid cycling is determined to “have more severe depressive symptoms, greater functional impairment, and poorer adherence to treatment, as well as higher risk of suicide,” the investigators said. Meanwhile, mania-dominant characteristics were attributed to non-rapid cycling.

The results of RLAI therapy in patients with BD type 1 showed “significantly delayed time to relapse in patients who relapse[d] more than 4 mood episodes in the 12 months prior to study entry,” the researchers stated.

Mirror studies were performed to gain a better understanding of real-world clinical practices and to determine whether RLAI performed similarly in various psychiatric disorders. Findings in both original case studies and mirror studies were that regular treatment with RLAI reduced relapse episodes and hospital visits, but increased medication costs.

“In addition, in contrast to non-rapid cycling patients, RLAI decreased the number of change-in-mood episodes in rapid cycling BD patients; which may provide additional insights into the treatment of rapid cycling BD,” the investigators said.

“BD patients had lower inpatient and ER resource use, and non-medication costs after using RLAI,” the researchers said.

Study Limitations

Limitations of this study included symptom severity, adverse events, true drug compliance, and the fact that only 287 out of 1919 patients were recruited for the study.

Reference

Hsieh MH, Chuang P, Wu C, Chang C, Chung P, Tang C. Bipolar patients treated with long-acting injectable risperidone in Taiwan: A 1-year mirror-image study using a national claims database [published online May 2017]. J Affect Disord. doi:http://dx.doi.org/10.1016/j.jad.2017.04.074