Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study.
OBJECTIVE: To evaluate the efficacy and safety of olanzapine, divalproex, and placebo in a randomized, double-blind trial in mild to moderate mania (DSM-IV-TR criteria). METHOD: The study was conducted from October 2004 to December 2006. A total of 521 patients from private practices, hospitals, an...
| Autors principals: | , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Idioma: | English |
| Publicat: |
2008
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| _version_ | 1826263073364639744 |
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| author | Tohen, M Vieta, E Goodwin, G Sun, B Amsterdam, J Banov, M Shekhar, A Aaronson, S Bardenstein, L Grecu-Gabos, I Tochilov, V Prelipceanu, D Oliff, H Kryzhanovskaya, L Bowden, C |
| author_facet | Tohen, M Vieta, E Goodwin, G Sun, B Amsterdam, J Banov, M Shekhar, A Aaronson, S Bardenstein, L Grecu-Gabos, I Tochilov, V Prelipceanu, D Oliff, H Kryzhanovskaya, L Bowden, C |
| author_sort | Tohen, M |
| collection | OXFORD |
| description | OBJECTIVE: To evaluate the efficacy and safety of olanzapine, divalproex, and placebo in a randomized, double-blind trial in mild to moderate mania (DSM-IV-TR criteria). METHOD: The study was conducted from October 2004 to December 2006. A total of 521 patients from private practices, hospitals, and university clinics were randomly assigned to olanzapine (5-20 mg/day), divalproex (500-2500 mg/day), or placebo for 3 weeks; those completing continued with a 9-week double-blind extension. Efficacy (mean change in Young Mania Rating Scale [YMRS] total score was the primary outcome) and safety were assessed. RESULTS: After 3 weeks of treatment, olanzapine-treated (N = 215) and placebo-treated (N = 105) patients significantly differed in YMRS baseline-to-endpoint total score change (p = .034; least squares [LS] mean: -9.4 and -7.4, respectively). Such changes were not significantly different between olanzapine vs. divalproex (N = 201) or divalproex vs. placebo. After 12 weeks of treatment, olanzapine- and divalproex-treated patients significantly differed in YMRS baseline-to-endpoint changes (p = .004; LS mean: -13.3 and -10.7, respectively). Of observed cases, 35.4% (35/99; 3 weeks) to 57.1% (28/49; 12 weeks) had valproate plasma concentrations lower than the recommended valproate therapeutic range, but these patients' YMRS scores were lower than those of patients with valproate concentrations above/within range. Compared with divalproex, after 12 weeks, olanzapine-treated patients had significant increases in weight (p < .001) and in glucose (p < .001), triglyceride (p = .003), cholesterol (p = .024), uric acid (p = .027), and prolactin (p < .001) levels. Divalproex-treated patients had significant decreases in leukocytes (p = .044) and platelets (p < .001) compared with olanzapine after 12 weeks of treatment. The incidence of potentially clinically significant weight gain (>/= 7% from baseline) was higher with olanzapine than with divalproex (3-week: p = .064, 6.4% vs. 2.7%; 12-week: p = .002, 18.8% vs. 8.5%; respectively). CONCLUSION: Olanzapine was significantly more efficacious than placebo but not divalproex at 3 weeks and significantly more efficacious than divalproex at 12 weeks. Olanzapine-treated patients had significantly greater increases in weight and in glucose, cholesterol, triglyceride, uric acid, and prolactin levels than divalproex-treated patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00094549. |
| first_indexed | 2024-03-06T19:45:54Z |
| format | Journal article |
| id | oxford-uuid:224a2068-fec8-41f0-a953-0767ba8ae439 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:45:54Z |
| publishDate | 2008 |
| record_format | dspace |
| spelling | oxford-uuid:224a2068-fec8-41f0-a953-0767ba8ae4392022-03-26T11:37:58ZOlanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:224a2068-fec8-41f0-a953-0767ba8ae439EnglishSymplectic Elements at Oxford2008Tohen, MVieta, EGoodwin, GSun, BAmsterdam, JBanov, MShekhar, AAaronson, SBardenstein, LGrecu-Gabos, ITochilov, VPrelipceanu, DOliff, HKryzhanovskaya, LBowden, C OBJECTIVE: To evaluate the efficacy and safety of olanzapine, divalproex, and placebo in a randomized, double-blind trial in mild to moderate mania (DSM-IV-TR criteria). METHOD: The study was conducted from October 2004 to December 2006. A total of 521 patients from private practices, hospitals, and university clinics were randomly assigned to olanzapine (5-20 mg/day), divalproex (500-2500 mg/day), or placebo for 3 weeks; those completing continued with a 9-week double-blind extension. Efficacy (mean change in Young Mania Rating Scale [YMRS] total score was the primary outcome) and safety were assessed. RESULTS: After 3 weeks of treatment, olanzapine-treated (N = 215) and placebo-treated (N = 105) patients significantly differed in YMRS baseline-to-endpoint total score change (p = .034; least squares [LS] mean: -9.4 and -7.4, respectively). Such changes were not significantly different between olanzapine vs. divalproex (N = 201) or divalproex vs. placebo. After 12 weeks of treatment, olanzapine- and divalproex-treated patients significantly differed in YMRS baseline-to-endpoint changes (p = .004; LS mean: -13.3 and -10.7, respectively). Of observed cases, 35.4% (35/99; 3 weeks) to 57.1% (28/49; 12 weeks) had valproate plasma concentrations lower than the recommended valproate therapeutic range, but these patients' YMRS scores were lower than those of patients with valproate concentrations above/within range. Compared with divalproex, after 12 weeks, olanzapine-treated patients had significant increases in weight (p < .001) and in glucose (p < .001), triglyceride (p = .003), cholesterol (p = .024), uric acid (p = .027), and prolactin (p < .001) levels. Divalproex-treated patients had significant decreases in leukocytes (p = .044) and platelets (p < .001) compared with olanzapine after 12 weeks of treatment. The incidence of potentially clinically significant weight gain (>/= 7% from baseline) was higher with olanzapine than with divalproex (3-week: p = .064, 6.4% vs. 2.7%; 12-week: p = .002, 18.8% vs. 8.5%; respectively). CONCLUSION: Olanzapine was significantly more efficacious than placebo but not divalproex at 3 weeks and significantly more efficacious than divalproex at 12 weeks. Olanzapine-treated patients had significantly greater increases in weight and in glucose, cholesterol, triglyceride, uric acid, and prolactin levels than divalproex-treated patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00094549. |
| spellingShingle | Tohen, M Vieta, E Goodwin, G Sun, B Amsterdam, J Banov, M Shekhar, A Aaronson, S Bardenstein, L Grecu-Gabos, I Tochilov, V Prelipceanu, D Oliff, H Kryzhanovskaya, L Bowden, C Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study. |
| title | Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study. |
| title_full | Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study. |
| title_fullStr | Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study. |
| title_full_unstemmed | Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study. |
| title_short | Olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania: a randomized, 12-week, double-blind study. |
| title_sort | olanzapine versus divalproex versus placebo in the treatment of mild to moderate mania a randomized 12 week double blind study |
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