In this newsletter, we include information about 6-month paliperidone palmitate for schizophrenia. We also share practical tips on the management of treatment-resistant obsessive-compulsive disorder, key points from a presentation on the psychopharmacology algorithm for psychotic depression, and our practical research summaries (Quick Takes).
Six-Month Paliperidone Palmitate (Invega HafyeraTM) for Schizophrenia
- What is 6-month paliperidone palmitate approved for?
- On September 1, 2021, the FDA approved 6-month paliperidone palmitate for the treatment of schizophrenia in adults.
- What is the difference between Invega Sustenna and Invega Trinza?
- Invega Sustenna is a 1-month injection, and Invega Trinza is a 3-month injection.
- What do we know about its efficacy?
- A randomized, double-blind phase 3 global study of patients ages 18–70 with schizophrenia showed that 92.5% of patients treated with Invega Hafyera were relapse free at 12 months. You can learn more here.
- How is 6-month paliperidone palmitate administered?
- Invega Hafyera is a long-acting gluteal intramuscular injection administered every 6 months.
- Before transitioning to Invega Hafyera, patients must be adequately treated with 1-month paliperidone palmitate for at least 4 months or 3-month paliperidone palmitate for at least one 3-month injection cycle.
- What are its most common side effects?
- The safety profile was consistent with previous studies of 1-month and 3-month paliperidone palmitate injection.
- The most common adverse reactions were upper respiratory tract infection (12%), injection site reaction (11%), weight increase (9%), headache (7%), and parkinsonism (5%).
- How might it be different from existing medications?
- Invega Hafyera is the first antipsychotic that can be administered twice yearly for adults with schizophrenia.
The manufacturer published a press release on September 1, 2021. Learn more.
Treatment-Resistant Obsessive-Compulsive Disorder With Robert Hudak, M.D.
In this interview, Dr. Robert Hudak discusses management strategies for obsessive-compulsive disorder. He describes the complex presentations of obsessive-compulsive disorder and reviews the central roles of SSRIs and ERP as first-line treatment approaches for OCD. He further discusses dosing strategies, the use of adjunct medications, and comorbid psychiatric conditions.
Interview highlights include the following:
- Although fear of contamination and pathological doubt account for the obsessions of a majority of people with OCD, obsessions can be about virtually everything.
- The main route of pharmacologic treatment for OCD is through serotonin reuptake inhibition, and that of psychotherapy is through exposure and response prevention therapy.
- Selective serotonin reuptake inhibitors for OCD may be best dosed by starting at low doses to establish tolerability, then immediately titrating to high doses to maximize response.
Learn more and earn 0.5 CME credits here.
The Psychopharmacology Algorithm for Psychotic Depression
In this presentation, Dr. David Osser guides clinicians on the use of medications and somatic treatments for the management of major depressive disorder with psychotic features. The video lecture focuses on the use of an algorithm, which reviews research on the efficacy, effectiveness, and side-effect burden of various psychopharmacologic strategies and electroconvulsive therapy for psychotic depression.
Node 2: Choosing an Antipsychotic for Psychotic Depression
- There are many studies on olanzapine and quetiapine for psychotic depression.
- Olanzapine and quetiapine have undesirable metabolic and other side effects.
- Ziprasidone and aripiprazole have comparable effectiveness and are better tolerated.
- Newer antipsychotics may have comparable safety but are unstudied and expensive.
- Avoid newer antipsychotics for now.
Learn more and earn 1.0 CME credit here.
Quick Takes: Informing Your Practice
Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19
- A 2-week course of full-dose fluvoxamine decreased clinical deterioration (development of dyspnea or oxygen saturation <92%) in outpatients with symptomatic COVID-19 infection. Learn more.
Comparison of the Metabolic Characteristics of Newer Second-Generation Antipsychotics
- Over 1 year, lurasidone caused no net weight gain, whereas olanzapine caused a gain of 10 pounds, in patients with mood disorders in a private outpatient clinic.
- For comparison, in the 1.5-year CATIE study, perphenazine was associated with a 2 lb. loss vs olanzapine’s 9.5 lb. gain. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
References
INVEGA HAFYERA™ [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc. August 2021.
