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Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT
Howard, Robert Cort, Elizabeth Bradley, Rosie Harper, Emma Kelly, Linda Bentham, Peter Ritchie, Craig Reeves, Suzanne Fawzi, Waleed Livingston, Gill
Howard, Robert
Cort, Elizabeth
Bradley, Rosie
Harper, Emma
Kelly, Linda
Bentham, Peter
Ritchie, Craig
Reeves, Suzanne
Fawzi, Waleed
Livingston, Gill
Abstract
A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points; p = 0.0002). In stage 2, BPRS scores improved by 1.1 point in those who continued with amisulpride but deteriorated by 5.2 points in those who switched from amisulpride to placebo, a difference of 6.3 points (95% CI 0.9 to 11.7 points; p = 0.024). Fewer participants allocated to the amisulpride group stopped treatment because of non-efficacy in stages 1 (p = 0.01) and 2 (p = 0.031). The number of patients stopping because of extrapyramidal symptoms and other side effects did not differ significantly between groups. Amisulpride treatment in the base-case analyses was associated with non-significant reductions in combined NHS, social care and unpaid carer costs and non-significant reductions in quality-adjusted life-years (QALYs) in both stages. Including patients who were intensive users of inpatient services in sensitivity analyses did not change the QALY result but resulted in placebo dominance in stage 1 and significant reductions in NHS/social care (95% CI -£8923 to -£122) and societal costs (95% CI -£8985 to -£153) for those continuing with amisulpride.
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Date
2018-11
Type
Article
Subject
Mental health, Pharmacology
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Citation
Howard R, Cort E, Bradley R, Harper E, Kelly L, Bentham P, Ritchie C, Reeves S, Fawzi W, Livingston G, Sommerlad A, Oomman S, Nazir E, Nilforooshan R, Barber R, Fox C, Macharouthu A, Ramachandra P, Pattan V, Sykes J, Curran V, Katona C, Dening T, Knapp M, Romeo R, Gray R. Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT. Health Technol Assess. 2018 Nov;22(67):1-62. doi: 10.3310/hta22670. PMID: 30507375; PMCID: PMC6304731.
Journal / Source Title
Health Technology Assessment
DOI
10.3310/hta22670
PMID
30507375
Publisher
NIHR Journals Library
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Publisher’s statement
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3021623.pdf
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