Patients With Bipolar I Willing to Trade More Symptoms for Relief From Side Effects of Oral AP, Survey Shows

A recent survey of patients with bipolar I (BP1) disorder showed the extent to which they are so bothered by side effects to antipsychotic (AP) medications that they will stop taking them, or will trade more symptoms for fewer side effects.

The results, which were presented at a recent meeting of mental health professionals, found that dislike of side effects (54%) was the most common reason for nonadherence. Other common reasons for nonadherence included not liking taking medication (37%), thinking that they did not need their medication (31%), and thinking that their medication was ineffective (23%).

Between 60% and 80% of individuals with BP1 have been treated with 1 or more oral AP medications, and while they are effective, they are associated with weight gain, drowsiness, sexual problems, and involuntary movements.

The online survey, with 200 participants, was informed by previous focus groups, said Leona Bessonova, PhD, director of Health Economics and Outcomes Research for Alkermes, which funded the study.

The impacts of side effects of oral AP on social functioning and work have not been well documented, she said. Nearly all of those asked (98%) experienced at least 1 of 12 oral AP side effects evaluated; in addition, each side effect evaluated was experienced by 62% of participants or more.

Respondents to the survey were asked if they found side effects "bothersome." The term was not defined for participants, she said.

The most common side effects (felt by 75% or more) included feeling drowsy/tired, lack of emotion, anxiety, dry mouth, and weight gain. Overall, anxiety and lack of emotion were the 2 side effects most frequently cited as affecting social interactions and relationships

Asked about their preference for a new oral AP, patients who participated in the survey chose improvements in many side effects, especially for weight gain and sexual dysfunction, over symptom relief. Interestingly, nearly 30% were willing to accept a slight worsening in symptoms in order to to see fewer side effects in those 2 areas.

Alkermes is planning to file a New Drug Application in the fourth quarter for ALKS 3831 (olanzapine/samidorphan) for both bipolar I and schizophrenia.

Reference

Bessonova L, Velligan DI, Yarlas A, et al. Antipsychotic treatment experiences of individuals with bipolar I disorder: findings from an online survey. Poster presented at: 2019 Psych Congress; October 3-6, 2019; San Diego, California.