medwireNews: The wide range of medications currently available for the treatment of bipolar disorder means that clinicians can tailor maintenance treatment to their patients’ individual needs, an observational study shows.
Patients in the study showed considerable diversity in disease and social characteristics, but despite this they achieved comparably high retention and low relapse rates on maintenance therapy, the study researchers report.
This shows that “medications are used by physicians with great knowledge and with focus on the individual patient and the needs of clinical practice,” they say.
Moreover, similar effects were achieved across the different treatments, the team observes, “hinting again at the capability of physicians and their patients to optimize individual treatment using the spectrum of medications available.”
A total of 761 outpatients with bipolar disorder (mean age, 48 years) participated in the study. Their baseline demographics varied considerably with regard to social situation, medical and psychiatric comorbidities, and disease course.
Maintenance medications at baseline included atypical antipsychotic monotherapy, anticonvulsants, mood-stabilizing medications, and combination treatments, including antipsychotic/mood-stabilizing medication and antipsychotic/anticonvulsant.
By the 18-month follow-up point, 87.7% of the patients were still taking the same baseline treatment, with no notable differences among the treatment groups. The overall mean time on mood-stabilizing treatment was 444.7 days (range, 377.5–481.3 days).
There was a 28.4% early discontinuation rate, which was low compared with rates observed in controlled trials, the researchers note. Loss to follow up was the reason in 8.3% of cases and patient decision in 3.9%. Risk factors for discontinuation included a non-stable social environment, severe last bipolar episode, comorbid psychiatric diseases, and rapid cycling.
Only 26% of patients relapsed, defined as at least a 2-point increase in the Clinical Global Impression-Bipolar (CGI-BP) score, a CGI-BP increase to above 3 points, hospitalization due to psychiatric disorders, or death due to bipolar disorder.
The researchers, led by Susanne Kraemer (Lilly Deutschland GmbH, Bad Homburg, Germany), observed that patients were more likely to remain on their medication if they consumed moderate levels of alcohol – possibly indicative of good social integration and wellbeing – and had good baseline adherence, fewer manic episodes, and a low baseline CGI-BP score.
They note in BMC Psychiatry that 80–90% of patients maintained a CGI-BP score of 3 or below, with little variation over the course of the study. “The aim of the maintenance treatment, i.e. stabilization, could thus be regarded as achieved,” they write. And although 87% of patients reported at least one adverse event from a predefined solicited checklist specific to the various medications – weight gain being the main one – these events did not lead to discontinuation.
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