A randomized, double‐blind, placebo‐controlled study of maintenance treatment with adjunctive risperidone long‐acting therapy in patients with bipolar I disorder who relapse frequently

Nov 20, 2009Bipolar disorders

Risperidone long-acting treatment to prevent relapse in people with frequently recurring bipolar I disorder

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Abstract

Adjunctive treatment with risperidone long-acting therapy significantly increased time to relapse in patients with bipolar disorder type I.

Time to relapse was longer in patients receiving adjunctive risperidone long-acting therapy compared to those receiving placebo.
Relapse rates were 23.1% with adjunctive risperidone compared to 45.8% with placebo, indicating a 2.3-fold higher risk of relapse with placebo.
Completion rates for the treatment were 60.0% for those on adjunctive risperidone versus 42.4% for placebo.
Adverse event-related discontinuations were 4.6% for adjunctive risperidone and 1.7% for placebo.
Common adverse events included tremor, insomnia, muscle rigidity, weight increase, and hypokinesia, with higher rates observed in the adjunctive risperidone group.

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OBJECTIVE: No large controlled trials have evaluated adjunctive maintenance treatment with long-acting injectable antipsychotics in patients with bipolar disorder. This study assessed whether adjunctive maintenance treatment with risperidone long-acting therapy (RLAT), added to treatment-as-usual (TAU) medications for bipolar disorder, delays relapse in patients with bipolar disorder type I.

METHODS: This study included patients with bipolar disorder type I with > or = four mood episodes in the 12 months prior to study entry. Following a 16-week, open-label stabilization phase with RLAT plus TAU, remitted patients entered a 52-week, double-blind, placebo-controlled, relapse-prevention phase. Randomized patients continued treatment with adjunctive RLAT (25-50 mg every two weeks) plus TAU (n = 65) or switched to adjunctive placebo injection plus TAU (n = 59). The primary outcome measure was time to relapse to any mood episode.

RESULTS: Of 240 enrolled patients, 124 entered double-blind treatment. Time to relapse was longer in patients receiving adjunctive RLAT (p = 0.010). Relapse rates were 23.1% (n = 15) with adjunctive RLAT versus 45.8% (n = 27) with adjunctive placebo; relative relapse risk was 2.3-fold higher with adjunctive placebo (p = 0.011). Completion rates were: adjunctive RLAT, 60.0% (n = 39) and adjunctive placebo, 42.4% (n = 25; p = 0.050). Adverse event (AE)-related discontinuations were 4.6% (n = 3) and 1.7% (n = 1), respectively. Common AEs (adjunctive RLAT versus adjunctive placebo) were: tremor (24.6% versus 10.2%), insomnia (20.0% versus 18.6%), muscle rigidity (12.3% versus 5.1%), weight increased (6.2% versus 1.7%), and hypokinesia (7.7% versus 0.0%).

CONCLUSIONS: Adjunctive RLAT significantly delayed time to relapse in patients with bipolar disorder type I who relapse frequently. Safety and tolerability of RLAT were generally consistent with that previously observed.

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A randomized, double‐blind, placebo‐controlled study of maintenance treatment with adjunctive risperidone long‐acting therapy in patients with bipolar I disorder who relapse frequently

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