Combo Therapy Can Be First-Line Approach in Manic Episodes

Combination therapy superior for efficacy, relapse prevention, with acceptable safety profile

THURSDAY, Nov. 1 (HealthDay News) -- Combination therapy is an acceptable first-line approach for manic episodes in terms of efficacy and prevention of relapse, with an acceptable safety profile, according to a review published online Oct. 25 in CNS Neuroscience & Therapeutics.

Pierre Alexis Geoffroy, from Institute National de la Santé et de la Recherche Médicale (INSERM) in Créeil, France, and colleagues reviewed the literature to identify randomized controlled studies, treatment guidelines, and comprehensive reviews regarding the use of combination treatment for manic episodes.

The researchers found that the literature validated the superiority of combination therapy over monotherapy in the manic phase in terms of efficacy and prevention of relapse. The safety profile was acceptable for combination therapy, although side effects were more frequent with combination therapy, and discontinuation rates due to adverse events were higher. Drug classification, the course of the disease, and the predominant polarity should all be considered before continuing treatment after a manic phase. Combinations of drugs including olanzapine and asenapine were associated with weight gain, as was risperidone to a lesser extent; combinations including quetiapine, haloperidol, and asenapine were associated with sedation; and combinations including aripiprazole were associated with akathisia.

"This review of literature leads us to suggest that combination therapy, including an atypical antipsychotic with lithium or valproate, may be considered as a first-line approach," the authors write. "An appropriate algorithm for making decisions about combination treatment needs to be developed and included in future guidelines."

Several authors disclosed financial ties to the pharmaceutical industry.

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