Place of the partial dopamine receptor agonist aripiprazole in the management of schizophrenia in adults: a Delphi consensus study.
Pierre-Michel Llorca, Philippe Nuss, Éric Fakra, Isabelle Alamome, Dominique Drapier, Wissam El Hage, Renaud Jardri, Stéphane Mouchabac, Marc Rabbani, Nicolas Simon, Marie-Noëlle Vacheron, Jean-Michel Azorin
Author Information
Pierre-Michel Llorca: Department of Psychiatry, Clermont-Ferrand University Hospital, Clermont Auvergne University, Clermont-Ferrand, France. pmllorca@chu-clermontferrand.fr.
Philippe Nuss: Psychiatry and Medical Psychology Department, Saint-Antoine Hospital, Paris Sorbonne University, Paris, France.
Éric Fakra: University Hospital Psychiatry Group, Saint-Étienne University Hospital, Saint-Étienne, France.
Isabelle Alamome: Department of Psychiatry, Polyclinic of Limoges, Limoges, France.
Dominique Drapier: University Hospital Adult Psychiatry Group, Guillaume-Régnier Hospital, University of Rennes 1, Rennes, France.
Wissam El Hage: UMR 1253, iBrain, Tours University, Inserm, Tours, France.
Renaud Jardri: Lille Neuroscience & Cognition Centre, INSERM U1172, Fontan Hospital, Lille University Hospital, Lille, France.
Stéphane Mouchabac: Psychiatry and Medical Psychology Department, Saint-Antoine Hospital, Paris Sorbonne University, Paris, France.
Marc Rabbani: Medical Affairs Department, Lundbeck SAS, Puteaux, France.
Nicolas Simon: Department of Clinical Pharmacology, Aix Marseille University, INSERM, SESSTIM, Hospital Sainte Marguerite, CAP, Marseille, IRD, France.
Marie-Noëlle Vacheron: Department of Psychiatry, Hospital Sainte Anne, Paris, France.
Jean-Michel Azorin: Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France.
BACKGROUND: Aripiprazole is a second-generation antipsychotic, efficacious in patients with schizophrenia during acute episodes. Due to its pharmacological profile, aripiprazole may be of interest in patients with specific clinical profiles who have not been studied extensively in randomised clinical trials. OBJECTIVES: To capture experience with aripiprazole in everyday psychiatric practice using the Delphi method in order to inform decision-making on the use of aripiprazole for the treatment of patients with schizophrenia in clinical situations where robust evidence from clinical trials is lacking. METHODS: The scope of the survey was defined as the management of schizophrenia in adults. A systematic literature review was performed to identify the different clinical situations in which aripiprazole has been studied, and to describe the level of clinical evidence. Clinical profiles to include in the Delphi survey were selected if there was a clear interest in terms of medical need but uncertainty over the efficacy of aripiprazole. For each clinical profile retained, five to seven specific statements were generated and included in a questionnaire. The final 41-item questionnaire was proposed to a panel of 406 French psychiatrists with experience in the treatment of schizophrenia. Panellists rated their level of agreement using a Likert scale. A second round of voting on eleven items was organised to clarify points for which a consensus was not obtained in the first round. RESULTS: Five clinical profiles were identified in the literature review (persistent negative symptoms, pregnancy, cognitive dysfunction, addictive comorbidity and clozapine resistance). Sixty-two psychiatrists participated in the first round of the Delphi survey and 33 in the second round. A consensus was obtained for 11 out of 41 items in the first round and for 9/11 items in the second round. According to the panellists' clinical experience, aripiprazole can be used as maintenance treatment for pregnant women, is relevant to preserve cognitive function and can be considered an option in patients with a comorbid addictive disorder or with persistent negative symptoms. CONCLUSION: These findings may help physicians in choosing relevant ways to use aripiprazole and highlight areas where more research is needed to widen the evidence base.
