Author:
Hart Xenia M.,Hiemke Christoph,Eichentopf Luzie,Lense Xenija M.,Clement Hans Willi,Conca Andreas,Faltraco Frank,Florio Vincenzo,Grüner Jessica,Havemann-Reinecke Ursula,Molden Espen,Paulzen Michael,Schoretsanitis Georgios,Riemer Thomas G.,Gründer Gerhard
Abstract
Abstract
Rationale
While one of the basic axioms of pharmacology postulates that there is a relationship between the concentration and effects of a drug, the value of measuring blood levels is questioned by many clinicians. This is due to the often-missing validation of therapeutic reference ranges.
Objectives
Here, we present a prototypical meta-analysis of the relationships between blood levels of aripiprazole, its target engagement in the human brain, and clinical effects and side effects in patients with schizophrenia and related disorders.
Methods
The relevant literature was systematically searched and reviewed for aripiprazole oral and injectable formulations. Population-based concentration ranges were computed (N = 3,373) and pharmacokinetic influences investigated.
Results
Fifty-three study cohorts met the eligibility criteria. Twenty-nine studies report blood level after oral, 15 after injectable formulations, and nine were positron emission tomography studies. Conflicting evidence for a relationship between concentration, efficacy, and side effects exists (assigned level of evidence low, C; and absent, D). Population-based reference ranges are well in-line with findings from neuroimaging data and individual efficacy studies. We suggest a therapeutic reference range of 120–270 ng/ml and 180–380 ng/ml, respectively, for aripiprazole and its active moiety for the treatment of schizophrenia and related disorders.
Conclusions
High interindividual variability and the influence of CYP2D6 genotypes gives a special indication for Therapeutic Drug Monitoring of oral and long-acting aripiprazole. A starting dose of 10 mg will in most patients result in effective concentrations in blood and brain. 5 mg will be sufficient for known poor metabolizers.
Funder
Zentralinstitut für Seelische Gesundheit (ZI)
Publisher
Springer Science and Business Media LLC
Cited by
12 articles.
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