symptom control, functioning, and hospitalization status in french patients changed from oral...
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ORIGINAL ARTICLE
Symptom control, functioning, and hospitalization status in Frenchpatients changed from oral atypical antipsychotics to risperidonelong-acting injectable
PIERRE-MICHEL LLORCA1, JEAN-PIERRE KAHN2, VERONIQUE MOREAU-MALLET3,
PHILIPPE BOUHOURS3 & the French StoRMi investigators group
1Service Hospitalier Universitaire, Psychiatrie B, Clermont-Ferrand, France, 2Service de Psychiatrie et Psychologie Clinique,
Centre Hospitalier Universitaire de Nancy, Hopital Jeanne d’Arc, Toul, France, and 3Janssen-Cilag SA, Issy-les-Moulineaux,
France
AbstractObjective. To investigate efficacy and tolerability of risperidone long-acting injectable (RLAI) in French patients withschizophrenia or other psychotic disorders, who were all switching from previous treatment with oral atypical antipsychotics.The impact of treatment with RLAI on the hospitalization status of these patients was also examined. Methods. Clinicallystable patients requiring a treatment change received 25 mg RLAI (increased to 37.5 or 50 mg if required) every 2 weeks for6 months. Results. Of 130 patients (68.5% male, mean age 36.2 years), most (83.8%) had DSM-IV schizophrenia (mainlyparanoid). Previous treatments were risperidone (80.8%), olanzapine (10.0%) and amisulpride (10.0%). Out of 66 patientshospitalized at baseline, 51 were outpatients at endpoint. Mean total PANSS, CGI-S and GAF scores were significantlyreduced from baseline to treatment endpoint (p B/0.001). Of those patients reported as moderate to severely ill at thebeginning of the trial (81.3%), fewer had the same classification at endpoint (50.8%). Mean scores for total ESRS andParkinsonism subscales were significantly reduced after only 1 month of treatment (p B/0.001). Conclusion. Treatment withRLAI significantly improved disease symptoms, functioning, hospitalization status, and reduced movement disorders, inpsychotic patients considered clinically stable on oral atypical antipsychotics.
Key Words: Schizophrenia, atypical antipsychotic, long-acting risperidone, tolerability, functioning, hospitalization
Introduction
Schizophrenia is a severe mental illness which is
ranked by the World Health Organization as the
eighth leading cause of long-term disability world-
wide [1]. Strategies for the optimal management of
patients with schizophrenia (and other psychotic
disorders) address not only the symptoms of the
illness, but are increasingly focussed on improving
functioning and quality of life, achieving remission,
and preventing relapse [2,3]. The atypical antipsy-
chotics are known to substantially improve the
positive, negative, affective, and cognitive symptoms
of schizophrenia [3,4]. Furthermore, they may also
be more effective than conventional neuroleptics in
improving quality of life and patient satisfaction with
treatment [5,6], and preventing relapse [7�9].
Prevention of relapse in patients with schizophre-
nia depends in particular on compliance with treat-
ment, and covert non-compliance is a major risk
factor for relapse and therefore rehospitalization
[8,10�12]. Other factors affecting relapse involve
demographics (age and gender) [12], severe residual
psychopathology [8], comorbid alcohol abuse
[11,12], and poor social relationships with family
and care providers [8]. The first episode of psychotic
illness has been identified as a key intervention point
for prevention of relapse [13]. Preliminary results
suggest that treatment with low doses of the oral
atypical antipsychotic risperidone could slow pro-
gression of schizophrenia and reduce relapse rates,
when given at an early stage of psychosis [13�15].
Nevertheless, the use of oral atypical antipsychotics
has not substantially improved the limited compli-
ance typically seen among patients on oral therapy
[16�20].
Injectable depot preparations of conventional
neuroleptics have played a traditional role in mana-
ging patients with schizophrenia. These injectable
preparations ensure delivery of medication, and
Correspondence: Dr. med. Philippe Bouhours, Janssen-Cilag S.A., 1 rue Camille Desmoulins, TSA 91003, 92787 Issy-les-Moulineaux Cedex 9, France. Tel:
�/33 1 5500 4053. E-mail: [email protected]
International Journal of Psychiatry in Clinical Practice, 2006; 10(4): 276�284
(Received 29 November 2005; accepted 6 March 2006)
ISSN 1365-1501 print/ISSN 1471-1788 online # 2006 Taylor & Francis
DOI: 10.1080/13651500600736767
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enable the attending physician to monitor the patient
for compliance with treatment. This is an important
first step in preventing relapse. Depot preparations
also reduce the daily fluctuations in drug plasma
concentrations associated with oral preparations.
This maximizes efficacy and tolerability of treatment
[21,22], along with patient satisfaction with their
medication [23]. Indeed, patients receiving depot
preparations are known to have lower rehospitaliza-
tion and relapse rates than those on oral medication
alone [2,24,25]. Compared with the atypical anti-
psychotics, conventional depot neuroleptics have a
lower efficacy with respect to negative symptoms,
generate more movement disorders [18], and induce
adverse events including pain at the injection site
[26,27]. The development of risperidone long-acting
injectable (RLAI) combines the advantages of an
injectable preparation with the clinical benefit of an
atypical antipsychotic [22,28].
Clinical studies have shown RLAI to be effective
for the short-term [29] and long-term [30] treat-
ment of patients with schizophrenia. Improvements
were observed in psychopathology [29,30], in
health-related quality of life [31,32], in symptom
remission [33], and in frequency and duration of
hospitalization [34,35]. This is particularly impor-
tant since hospitalization is a major cost driver in the
treatment of patients with schizophrenia [36]. A
reduction in severity of movement disorders was also
observed among patients on RLAI medication
[37,38].
The Switch to Risperidone Microspheres
(StoRMi) trial investigated the efficacy and safety
of switching patients with schizophrenia or related
psychotic disorders (and who required a change in
their medication) to RLAI, without first administer-
ing an oral risperidone run-in [32]. This paper
reports the findings from a subgroup of French
patients who were changed directly to RLAI from
oral atypical antipsychotics (mainly oral risperi-
done). Some emphasis was placed on investigating
the effect of treatment with RLAI on hospitalization
rate among these patients.
Patients and methods
This analysis formed part of a non-randomized,
single-arm, multicentre European trial of 6 months
duration. Objectives were to evaluate the efficacy,
tolerability and safety of transferring patients with
schizophrenia or other psychotic disorders to RLAI
medication without an oral risperidone run-in. The
trial was conducted in accordance with the
ICH-Good Clinical Practice Guidelines, the De-
claration of Helsinki, and the local laws and
regulations. The study protocol was reviewed and
approved by the appropriate Independent Ethics
Committees.
Patients
Patients enrolled in the trial had a psychiatric history
of schizophrenia or other psychotic disorders defined
by the Diagnostic and Statistical Manual of Mental
Disorders, 4th edition (DSM-IV) [39], and were
considered to require a change in their current
medication by the attending physician.
All patients were at least 18 years old and they (or
their legal representatives) provided written in-
formed consent prior to enrollment. Patients were
required to be symptomatically stable, and on a fixed
dose of one or more antipsychotic drugs for at least 1
month before the screening visit. They could either
be hospitalized or outpatients at the time of enroll-
ment and during the trial.
Patients were excluded from the trial if they were
known to be intolerant or non-responsive to risper-
idone, had received treatment with clozapine during
the previous 3 months, or had participated in
another investigational drug trial within 30 days
prior to enrollment. Those with a serious unstable
medical condition including clinically relevant la-
boratory abnormalities, a history or current symp-
toms of tardive dyskinesia and neuroleptic malignant
syndrome were also excluded from the trial. Preg-
nant or breast-feeding women were excluded, whilst
others of childbearing ability were required to use
adequate contraception and show a negative urine
pregnancy test at the screening visit.
Medication
Risperidone long-acting injectable (RLAI) was given
by intramuscular (gluteal) injection every 2 weeks.
The recommended starting dose was 25 mg, but
patients suffering from persistent symptoms or
known only to respond to higher doses of antipsy-
chotics could be started with doses of either 37.5 or
50 mg. Thereafter, the dosage of RLAI was adjusted
to suit the individual patient’s symptoms and re-
sponse to treatment.
Since RLAI was administered without an oral
risperidone run-in, it was recommended that toler-
ability to risperidone was established in those
patients with no previous history of risperidone
use. These patients received 2�/1 mg oral risper-
idone once daily for 2 days prior to treatment with
RLAI. Patients treated previously with an oral
antipsychotic continued to receive that drug at the
same dose for 21 days following the first injection
with RLAI, after which it was stopped or tapered off
within 3 days. Patients treated previously with
conventional depot neuroleptics were changed to
RLAI according to a procedure described previously
[32].
Patients were allowed to continue receiving other
psychotropic medications prescribed prior to the
trial (e.g., for sleep induction or sedation), provided
the dose remained stable. Oral risperidone supple-
Direct change to risperidone long-acting injectable 277
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mentation was used to manage any exacerbation of
psychotic symptoms between study visits which
required an immediate dose adjustment, and also
for up to 3 weeks after an increase in the dose of
RLAI if an immediate clinical effect was needed.
Patients could also receive benzodiazepines as rescue
medication for periods not exceeding ten consecu-
tive days during the trial.
Assessments
Treatment efficacy was assessed at baseline and
thereafter at 1, 3 and 6 months (trial endpoint)
using the Positive and Negative Syndrome Scale
(PANSS). The primary efficacy criterion was the
mean change from baseline in PANSS total score at
endpoint. Secondary efficacy assessments were
made using the following rating scales during the
6-month trial period. Clinical Global Impression-
Disease Severity (CGI-S) evaluated disease severity
at baseline and thereafter at 1, 3 and 6 months. The
CGI-S categorized patients according to whether
they were ‘‘severely ill’’, ‘‘markedly ill’’, ‘‘moderately
ill’’, ‘‘mildly ill’’, ‘‘borderline ill’’, or ‘‘normal’’.
Global Assessment of Functioning (GAF) evaluated
the functional status of patients at baseline and at
endpoint on a scale where 100 represented the best
functioning outcome. The MOS 36-Item Short-
Form Health Survey (SF-36) evaluated the health-
related quality of life of patients at baseline, after
3 months and at endpoint. Patient satisfaction with
treatment was rated at baseline and at endpoint
according to whether it was considered ‘‘very
good’’, ‘‘good’’, ‘‘moderate’’, ‘‘poor’’ or ‘‘very
poor’’.
The severity of movement disorders was evaluated
at baseline and thereafter at 1, 3 and 6 months using
the Extrapyramidal Symptoms Rating Scale (ESRS).
Adverse events, vital signs and body weight were
recorded during the same study visits.
Statistical analyses
Safety analyses were performed using data from the
intention-to-treat (ITT) population, which com-
prised all patients receiving at least one dose of
RLAI. Efficacy analyses were performed using data
from patients in the ITT population who had at least
one post-baseline efficacy assessment. Efficacy data
were analysed using the last-observation-carried-
forward (LOCF) method. Data were presented as
mean9/standard deviation unless otherwise stated.
Changes from baseline to endpoint in PANSS
scores, CGI-S, GAF, SF-36, patient satisfaction
with treatment, and ESRS scores were analysed
using the Wilcoxon signed-rank test (two-tailed) at
the 5% significance level.
Results
Patient demographics
The original trial involved 1876 patients. Of the 202
patients recruited in France, 130 were switched from
oral atypical antipsychotics to RLAI. This subgroup
of patients formed the basis for the present analysis.
Baseline demographic and psychiatric characteristics
of this subgroup entering the trial are shown in Table
I. Most patients were diagnosed with schizophrenia
(83.8%), and 61.5% of these suffered from the
paranoid subtype.
Medication
At trial entry, the atypical antipsychotics given were
risperidone (80.8%), olanzapine (10.0%) and ami-
sulpride (10.0%) (Table II). In addition, some
patients received conventional oral neuroleptics
(2.3%), and/or conventional depot neuroleptics
(6.2%). Most patients were on monotherapy
(86.2%) while those on polytherapy (18 patients)
were switched to RLAI from one antipsychotic (3
patients), or more than one antipsychotic (15
patients) drug in their treatment regimens. Patients
were switched to RLAI for various reasons including
non-compliance (64.6%), insufficient efficacy
(18.5%), side effects (mostly movement disorders,
5.4%), and other reasons (18.5%) all associated with
their previous medication.
Table I. Baseline demographic and psychiatric characteristics of
the French subgroup of patients switched from atypical anti-
psychotics to RLAI.
Number of patients 130
Males/females 89 (68.5%)/
41 (31.5%)
Race:
Caucasian 109 (83.8%)
Oriental 8 (6.2%)
Black 7 (5.4%)
Hispanic 2 (1.5%)
Other 4 (3.1%)
Age (year)a 36.29/11.5
Height (cm)a 171.09/9.4
Weight (kg)a 76.19/14.8
Body Mass Index (kg/m2)a 26.19/5.0
Diagnosis (DSM-IV):
Schizophrenia 109 (83.8%)
Schizoaffective disorder 13 (10.0%)
Schizophreniform disorder 3 (2.3%)
Other 5 (3.8%)
Psychiatric history:
Age at onset of symptoms (years)a 23.59/7.3
Age at diagnosis (years)a 26.09/8.1
Ever hospitalized 127 (97.7%)
Hospitalized at baseline 66 (50.8%)
Hospitalized at endpoint 22 (16.9%)
Previous hospitalizationsa 6.99/7.8
aMean9/SD.
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The majority of patients received RLAI at an
initial starting dose of 25 mg (80.8%), and those
remaining received dosages of either 37.5 mg
(12.3%) or 50 mg (6.9%). At trial endpoint, the
proportion of patients receiving the 25 mg dosage
was 44.9%, whereas those receiving dosages of 37.5
and 50 mg were 19.7% and 34.6%, respectively.
During the trial, 17.7% of patients received oral
risperidone supplementation at a mean mode dosage
of 3.39/1.4 mg for a mean duration of 32.79/27.1
days.
Compliance and hospitalizations
The trial had a high completion rate (70.0%), with
only 3.1% discontinuing treatment with RLAI due
to non-compliance. Other reasons for discontinuing
treatment with RLAI included withdrawal of consent
(10.0%), insufficient efficacy (6.2%), loss to follow-
up (5.4%), adverse events (2.3%), and others
(3.1%). Out of 66 patients hospitalized at baseline,
51 were outpatients at endpoint. However, seven of
those patients hospitalized at endpoint had not been
hospitalized at baseline.
Treatment efficacy
Efficacy analysis was performed on data available for
128 patients. There was a significant decrease in
mean total PANSS score from 78.39/24.1 (97.5%
confidence interval 73.5�83.2) at baseline to 67.89/
26.6 (97.5% confidence interval 62.5�73.1) at trial
endpoint (p B/0.001). This corresponded with a shift
from baseline score of �/10.59/22.1. A significant
reduction in patient symptoms was apparent after
only 1 month of treatment with RLAI, and improve-
ment continued until the trial endpoint (Figure 1).
At endpoint, 41.4% of patients displayed a ]/20%
improvement in the total PANSS score compared
with baseline. Significant improvements (p 5/0.001)
from baseline to endpoint were also observed in
scores for the PANSS positive (16.59/7.0 vs. 15.09/
8.1), negative (22.79/8.1 vs. 18.89/7.9) and general
psychopathology subscales (39.29/12.5 vs. 34.19/
13.4).
All Marder factors [40] (except for uncontrolled
hostility/excitement factor) improved significantly
(p B/0.001) from baseline to endpoint (Figure 2).
Other assessments showed significant improve-
ments in the CGI-S (p B/0.001). Of those patients
reported as moderate to severely ill at the beginning
of the trial (81.3%), fewer had the same classifica-
tion at endpoint (50.8%) (Figure 3). Patient func-
tioning determined from the mean GAF score was
also significantly improved (p B/0.001) from baseline
(53.29/15.8) to endpoint (59.89/19.9). Further-
more, the percentage of patients rating their satisfac-
tion with treatment as ‘‘very good’’ increased from
baseline (11.6%) to endpoint (29.5%). Health-
related quality of life (SF-36) improved during the
trial, with significant increases from baseline to
endpoint (p B/0.05) in mean scores for all SF-36
factors except vitality (Figure 4). Clinically signifi-
Table II. Survey of antipsychotic drugs used by the French
subgroup of patients before switching to RLAI.
Antipsychotic drug Number of
patientsa
Mean dose
(mg/day)
Conventional oral neuroleptics 3 (2.3%)
Haloperidal 1 90.0
Levomepromazine 2 125.09/35.4
Conventional depot neuroleptics 8 (6.2%)
Flupentixol decanoate 1 1.4
Fluphenazine decanoate 1 37.5
Haloperidol decanoate 3 7.69/5.5
Pipotiazine palmitate 2 8.09/3.8
Zuclopenthixol decanoate 1 14.3
Atypical antipsychotics 130 (100%)
Amisulpride 13 538.59/352.5
Olanzapine 13 19.29/10.0
Risperidone 105 6.49/3.0
aSome patients were switched from more than one drug.
60
65
70
75
80
Mea
n to
tal P
AN
SS
sco
re
Mean 78.3 71.9 70.2 64.5 67.8
Standard deviation 24.1 26.4 28.4 25.6 26.6
Number of patients 128 126 115 104 128
Baseline Month 1 Month 3 Month 6 Endpoint
Figure 1. Total PANSS scores at each visit and at trial endpoint (p B/0.001 all shifts versus baseline).
Direct change to risperidone long-acting injectable 279
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cant improvements (�/5 points) occurred in physical
functioning, role physical, bodily pain, general
health, social functioning, role emotional, and men-
tal health factors.
Drug safety
Mean scores for total ESRS and Parkinsonism
subscales were both significantly reduced after only
1 month of treatment (p B/0.001), and continued to
improve until endpoint (Figure 5). The remainder of
ESRS subscales (except CGI-S for dystonia), were
also significantly improved from baseline to endpoint
(p B/0.05). Overall, 34.6% of patients used anti-
parkinson medication (not pre-defined in the proto-
col) at any given time after baseline.
Patients displayed no statistically significant
changes in vital signs during the trial period. Treat-
ment emergent adverse events were reported in 82
patients and most frequently included anxiety
(13.1%), weight increase (9.2%), and insomnia
(8.5%). Only small increases in mean body weight
(75.79/14.0 kg at baseline vs. 75.99/14.6 kg at
endpoint) were observed. Treatment emergent im-
potence, diabetes mellitus and pain at the injection
site were also reported by one patient (0.8%) each.
According to the physician’s judgement, there was
no causal link between the death of one patient
during the trial (due to suicide) and treatment with
RLAI.
Discussion
The findings from this analysis support published
results from the StoRMi trial population [32], and
are consistent with other studies where RLAI was
given either with [29�31], or without [41], an oral
risperidone run-in. Even though all patients in the
French subgroup were required to be symptomati-
cally stable before entering the trial, and although
they were receiving oral atypical antipsychotics, they
still showed improvement when changed to RLAI.
The change to RLAI resulted in significant improve-
ments in symptom control (PANSS total score,
Marder factor scores and CGI-S score), in function-
ing capacity (GAF scores), and in health-related
0
2
4
6
8
10
12
14
16
18
20
22
Baseline (128 patients)
Month 1 (126 patients)
Month 3 (115 patients)
Month 6 (104 patients)
Endpoint (128 patients)
Mea
n PA
NS
S s
ubsc
ale
scor
es
for
Mar
der
fact
ors
Positive symptoms factor Negative symptoms factor
Disorganized thoughts factor Uncontrolled hostility/excitement factor
Anxiety/depression factor
Figure 2. PANSS subscale scores for Marder factors at each visit and at trial endpoint (pB/ 0.001 all shifts versus baseline for all factors,
except for uncontrolled hostility/excitement factor).
12.5
39.1
29.7
10.97.8
0
7.8
22.720.3 19.5
21.9
6.3
0
10
20
30
40
Sever
ely ill
Mar
kedly
ill
Mod
erat
ely ill
Mild
ly ill
Borde
rline
ill
Norm
al, n
ot a
t all i
ll
% p
atie
nts
Baseline Endpoint
Figure 3. Clinical Global Impression-Disease Severity (CGI-S) at baseline and trial endpoint (p B/0.001 all shifts versus baseline).
280 P.-M. Llorca et al.
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quality of life (SF-36 scores) among these patients.
These improvements may account for the better
health-related quality of life experienced by patients,
and are consistent with the findings from a previous
placebo-controlled study using RLAI to treat schizo-
phrenia [31]. Improvements were achieved without
having to treat the majority of patients with the
highest recommended dose of RLAI (50 mg).
Indeed, 44.9% of patients were being treated with
the lowest available dose of RLAI (25 mg) at trial
endpoint.
The present study had a high completion rate
(70.0%), with only 3.1% of patients discontinuing
their treatment with RLAI due to non-compliance.
This compared favorably, with 64.6% who were
reported to be non-compliant on their previous
treatment despite the fact that all were receiving an
oral atypical antipsychotic. Only 6.2% of patients
discontinued their treatment with RLAI due to
insufficient efficacy, compared with 18.5% who
changed from oral atypical antipsychotics for this
reason. A small percentage of patients (2.3%)
discontinued treatment with RLAI due to adverse
events.
The beneficial effects of RLAI with respect to
adverse events may reflect the more stable drug
plasma levels achieved with RLAI compared with
oral therapy [28]. Some patients (9.2%) reported
weight increases during treatment with RLAI. How-
ever, these increases in mean body weight were small
(0.2 kg) and not significant. Furthermore, move-
ment disorders (total ESRS and Parkinsonism sub-
scale scores) among the French subgroup of patients
were also significantly reduced during treatment
with RLAI.
Patients were generally satisfied with RLAI treat-
ment, and the proportion rating their satisfaction as
‘‘very good’’ increased from 11.6% at the beginning
of the trial to 29.5% at the endpoint. Improvements
in symptom control, health-related quality of life,
and patient satisfaction, probably influenced the
better compliance with treatment seen among pa-
tients on RLAI.
The prevention of relapse in patients with schizo-
phrenia depends on compliance with treatment, and
non-compliance carries a high risk for relapse and
subsequent rehospitalization [8,10�12]. Treatment
with RLAI reduced the hospitalization rate of
patients in the French subgroup (of 66 patients
hospitalized at baseline, 51 were outpatients at
endpoint), and confirmed findings from other stu-
dies where patients were switched to RLAI from
their previous medication [32,34,35,42]. Lower
hospitalization rates would be expected to reduce
overall psychiatric healthcare costs for patients with
schizophrenia and other psychotic disorders [35].
Therefore, the option of treating patients with RLAI
could potentially result in substantial cost saving
benefits in psychiatric healthcare.
Since the present analysis showed RLAI to have
beneficial improvements over oral atypical antipsy-
chotics, we would also expect RLAI to be a success-
0
5
10
15
Physic
al fu
nctio
ning
Role p
hysic
al
Bodily
pain
Gener
al he
alth
Vitality
Social
func
tionin
g
Role e
mot
ional
Men
tal h
ealth
Physic
al co
mpo
nent
Men
tal c
ompo
nent
Mea
n ch
ange
from
bas
elin
e
Figure 4. Health-related quality of life (SF-36) at baseline and
trial endpoint (p B/0.05 shift versus baseline for all scales except
for vitality).
2
3
4
5
6
Mea
n su
bsca
le s
core
Mean total ESRS Mean Parkinsonism
Mean total ESRS 5.8 4.8 4.4 3.0 3.2
Mean Parkinsonism 4.7 3.7 3.3 2.3 2.5
Number of patients 128 127 115 104 128
Baseline Month 1 Month 3 Month 6 Endpoint
Figure 5. Total ESRS and Parkinsonism subscale scores at each study visit and trial endpoint (p B/0.001 all shifts versus baseline).
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ful treatment intervention for patients suffering from
early schizophrenia. As patients participating in the
analysis were not in the early stages of schizophrenia,
and most had been previously hospitalized (97.7%)
up to several times (6.99/7.8 hospitalizations per
patient) for psychiatric reasons, we are unable to
elaborate further on this hypothesis.
In conclusion, RLAI is an important addition to
the options available for long-term treatment of
patients requiring antipsychotic therapy. Treatment
with RLAI is well tolerated and associated with a
high efficacy, good health-related quality of life, few
side effects (including movement disorders), and a
high level of patient satisfaction. All of these
attributes could contribute to improvements in
patient compliance with treatment. Moreover, the
ability of RLAI to improve the psychotic condition of
patients already stabilized on oral atypical antipsy-
chotics is particularly important. This was achieved
without having to treat the majority of patients with
the highest recommended dose of RLAI (50 mg). In
addition, the lower hospitalization rates among
patients treated with RLAI would be expected to
confer significant savings in the cost of psychiatric
healthcare.
Key points
. The tolerability and efficacy of risperidone
long-acting injectable (RLAI) was investigated
in French patients with schizophrenia or other
psychotic diseases
. Patients were transitioned directly to RLAI
from their previous treatment with oral atypical
antipsychotics
. RLAI significantly improved disease symptoms,
functioning and hospitalization rate in treated
patients
. Movement disorders were also significantly
reduced after treatment with RLAI
. Treatment using RLAI is a safe and effective
option for patients with schizophrenia and other
psychotic disorders
Acknowledgements
We would like to thank the French StoRMi investi-
gators group:
Dr. Isabelle Chereau, Service Hospitalier Universi-
taire, Clermont-Ferrand; Dr. Serge Schong, CMP
La Faıencerie, Mont Saint Martin; Dr. Catherine
Chassagne, CMP La Faıencerie, Mont Saint Martin;
Dr. Veronique Adnet Markovitch, CMP La Faıenc-
erie, Mont Saint Martin; Dr. Stephane Keller, CMP
La Faıencerie, Mont Saint Martin; Dr. Amal Bad-
dou, Centre Hospitalier Camille Claudel, La Cour-
onne; Dr. Paul Bonnan, Centre Hospitalier Cadillac,
Cadillac; Dr. Thierry Bottai, Centre Hospitalier de
Martigues, Hopital du Vallon, Martigues; Dr. Eric
Pellegrin, Centre Hospitalier de Martigues, Hopital
du Vallon, Martigues; Dr. Veronique Roure, Centre
Hospitalier Specialise Leon Jean Gregory, Thuir;
Dr. Rene Cariou, Centre Hospitalier Specialise Leon
Jean Gregory, Thuir; Dr. Alexandre Christodoulou,
EPS de Perray Vaucluse, Epinay Sur Orge; Dr.
Philippe Coffinet, Centre Hospitalier Specialise
Saint Remy, Saint Remy; Dr. Bruno Richelet,
Centre Hospitalier Specialise Saint Remy, Saint
Remy; Dr. Padrig Cullerre, Clinique Saint Vincent,
Larmor Plage; Prof. Jean-Marie Danion, CHRU
Hopital Civil, Strasbourg; Dr. Marie-Agathe Zim-
mermann, CHRU Hopital Civil, Strasbourg; Dr.
Renaud De Beaurepaire, Etablissement Psychiatri-
que Specialise Paul Guiraud, Villejuif; Dr. Jacques
Debieve, Centre de soins Ulysse Trelat, St Andre lez
Lille; Dr. Laurent Desbancs, CMP Du Bas Land-
reau, Reze; Dr. Dominique Drapier, CHSP Guil-
laume Regnier, Rennes; Dr. Philippe Dumont,
Centre Medico-Psychologique, Roubaix; Dr. Cathe-
rine Van Nedervelde, Centre Medico-Psycho-
logique, Roubaix; Dr. Sylvie Platteau, Centre
Medico-Psychologique, Roubaix; Dr. Xavier Xi-
beras, CH de Mont de Marsan-Site Sainte Anne,
Mont de Marsan; Dr. Philippe Durst, Centre
Hospitalier Ste Marie, Privas; Dr. Bernard Etche-
garay, Centre Hospitalier Specialise Charles Perrens,
Bordeaux; Dr. Andre Gassiot, Centre Hospitalier
Ste Marie, Rodez; Dr. Didier Mergaux, Centre
Hospitalier Ste Marie, Rodez; Dr. Alain Gavaudan,
Centre Hospitalier Specialise Valvert, Marseille; Dr.
Claude Guinard, Centre Hospitalier Specialise Val-
vert, Marseille; Dr. Jean Louis Lebeau, Centre
Hospitalier Specialise Valvert, Marseille; Dr. Nicolas
Lafay, Centre Hospitalier Henri Laborit, Poitiers;
Dr. Marie Benedicte Girard, Centre Hospitalier
Henri Laborit, Poitiers; Dr. Christian Guggiari,
Centre Hospitalier Specialise Beauregard, Bourges;
Dr. Emmanuel Dufumier, Centre Hospitalier Spe-
cialise Ste Marie, Le Puy en Velay; Dr. Rene
Clement, Centre Hospitalier Specialise Ste Marie,
Le Puy en Velay; Dr. Naceur Haddouche, Centre
Hospitalier Specialise Ste Marie, Le Puy en Velay;
Dr. Jean-Lou, Lavaud, Etablissement Psychiatrique
Specialise Paul Guiraud, Villejuif; Dr. Herve Le
Duc, Centre Psychotherapique de Gireugne, Saint
Maur; Dr. Vincent Delaunay, Centre Hospitalier
Universitaire St Jacques, Nantes; Dr. Eric Esposito,
Centre Hospitalier Universitaire St Jacques, Nantes;
Dr. Jean-Christophe Loirat, Centre Hospitalier Uni-
versitaire St Jacques, Nantes; Dr. Emile Roger
Lombertie, Centre Hospitalier Esquirol, Limoges;
Dr. Isabelle Alamome, Centre Hospitalier Esquirol,
Limoges; Dr. Pierre Chenivesse, Institut Marcel
Riviere, Le Mesnil St Denis; Dr. Eric Marcel,
Institut Marcel Riviere, Le Mesnil St Denis; Dr.
Martine Pelicier, Institut Marcel Riviere, Le Mesnil
St Denis; Dr. Jean-Albert Meynard, Hopital Marius
Lacroix, La Rochelle; Dr. Pierre Murry, CHS Saint
282 P.-M. Llorca et al.
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Egreve, Saint Egreve; Dr. Pascal Favre, CHS Saint
Egreve, Saint Egreve; Dr. Didier Feray, Centre
Hospitalier General, Dieppe; Dr. Annie Navarre-
Coulaud, Centre Hospitalier General, Dieppe; Dr.
Michel Nguyen Thanh Tong, CHS de la Sarthe,
Allonnes; Dr. Eric Gokalsing, Centre Hospitalier
Specialise Ste Marie, Nice; Dr. Jerome Palazzolo,
Centre Hospitalier Specialise Ste Marie, Nice; Dr.
Mohammed Beyadh, Centre Hospitalier Specialise
Haute Marne, Saint-Dizier; Dr. Catherine Perdrizet
Chevallier, Centre Hospitalier Specialise Hte
Marne, Saint-Dizier; Prof. Charles-Siegfried Peretti,
Hopital Robert Debre, Reims; Dr. Claire Lise
Charrel, Hopital Robert Debre, Reims; Dr. Philippe,
Sastre Garau, Centre de Sante Mentale MGEN,
Lille; Dr. Christian Plumecocq, Centre de Sante
Mentale MGEN, Lille; Prof. Dominique Pringuey,
CHU Nice Hopital Pasteur, Nice; Dr. Michel
Benoit, CHU Nice Hopital Pasteur, Nice; Dr.
Christine Lerouge, CH Intercommunal Toulon-La
Seyne/Mer, Toulon; Dr. Philippe Raymondet, CH
Intercommunal Toulon-La Seyne/Mer, Toulon;
Dr. Dominique Robert, Centre Hospitalier de
Saumur, Saumur; Dr. Christian Amouzou, EPS
Paul Guiraud, Villejuif; Dr. Juliette Gremion, EPS
Paul Guiraud, Villejuif; Dr. Annie Ruat, EPS Paul
Guiraud, Villejuif; Dr. Anne Rauzy, EPS Paul
Guiraud, Villejuif; Dr. Mohamed Saoud, Centre
Hospitalier Specialise Le Vinatier, Bron; Dr. Halima
Zeroug Vial, Centre Hospitalier Specialise Le Vina-
tier, Bron; Dr. Helene Mandran, Centre Hospitalier
Specialise Le Vinatier, Bron; Prof. Laurent Schmitt,
Centre Casselardit, Toulouse; Dr. Virginie Rouch,
Centre Casselardit, Toulouse; Dr. Stephane Torres,
CHRU Hopital La Colombiere, Montpellier; Dr.
Jean-Philippe Boulenger, CHRU Hopital La Co-
lombiere, Montpellier; Dr. Delphine Capdevielle,
CHRU Hopital La Colombiere, Montpellier; Dr.
Yves Tyrode, Centre Hospitalier Specialise, Mont-
favet; Dr. Daniel Choain, Centre Hospitalier Spe-
cialise, Montfavet; Dr. Pierre Vaneecloo, Centre
Psychotherapeutique Duchesnois de St Saulve, St
Saulve; Dr. Annie Viala, Etablissement Psychiatri-
que Specialise Ste Anne, Paris; Dr. Laurent Masclet,
Etablissement Psychiatrique Specialise Ste Anne,
Paris.
Statement of interest
This study was supported by Janssen Cilag Medical
Affairs EMEA, Beerse, Belgium.
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