Amisulpride as an adjunctive to clozapine in treatment-resistant schizophrenia

• Autor(a) principal: Santos, Carla Sofia de Sousa
• Data de Publicação: 2021
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/11417
• topic: Amissulprida; Clozapina; Esquizofrenia; Psicose; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Introduction: Schizophrenia is the paradigm of severe mental illness, being its treatment a great challenge since its recognition. About ? to ½ of patients do not respond or only show a partial response to antipsychotic treatment, for whom clozapine is recommended, which is effective in 30-50% of patients with treatment-resistant schizophrenia but requires regular monitoring due to agranulocytosis risk and several other common adverse effects. In addition, a significant minority of these patients maintain important symptoms, despite treatment with clozapine. For those, there are no approved interventions, with studies hypothesizing benefits with drug combinations and electroconvulsive therapy. Amisulpride, as an adjunctive to clozapine, has been considered a potential therapeutic alternative for its complementary pharmacological profile and the possibility of counteracting adverse effects induced by clozapine. Methods: A literature search was performed in PubMed (MEDLINE), Scopus and Cochrane Library, with “clozapine”, “amisulpride” and “schizophrenia” or “psychosis”, yielding 856 articles. Thirteen were suitable for this comprehensive systematic review, of which 7 were interventional studies (randomized controlled trials and pre-post), 1 observational study (retrospective) and 5 descriptive studies (case series and case reports). Only two studies were suitable for meta-analysis. Results: Amisulpride as an adjunctive to clozapine appeared to be effective in descriptive and observational studies and in a few interventional studies. However, it did not show superiority in some interventional and higher quality studies. A reduction in some of clozapine’s side effects (sialorrhea mostly) was reported in some studies. Discussion: Amisulpride when added to clozapine therapy apparently revealed a slight clinical improvement in patients with treatment-resistant schizophrenia, compared to placebo. However, the scarcity of studies exploring the efficacy of amisulpride as an add-on, with studies quality ranging from moderate to very low, preclude definite conclusions. Further research is needed so this add-on therapy can be included in standard treatment algorithms. Due to the possibility of a wide range of benefits to be observed with amisulpride, it is advised that some concomitant disturbances, such as substance use, violence, and clozapine’s side effects, should be also assessed.