Two-injection start regimen of long-acting aripiprazole for bipolar disorder: tips and tricks for better efficacy and tolerability

Objective: To comparatively evaluate the efficacy and safety of the two aripiprazole long-acting injectable (LAI) initiation regimens, including one-injection start (OIS) regimen and two-injection start (TIS) regimen, in patients with bipolar disorder (BD). Methods: A total of 46 BD patients experiencing acute manic episodes with psychotic or mixed features were included in this observational study. Patients were divided into two groups based on the aripiprazole LAI initiation regimen including OIS group (n=23; patients received a single 400 mg LAI injection on Day 1, followed by oral aripiprazole (15-20 mg/day) for 14 days) and TIS group (n=23; patients received two 400 mg doses of aripiprazole LAI administered on the same day together with a single 20 mg oral dose of aripiprazole). Data on patient demographics, clinical characteristics and previous hospitalization were retrieved from hospital records. The effectiveness of the treatment was evaluated based on the Young Mania Rating Scale (YMRS) and Hamilton Depression Scale (HAM-D) scores recorded on Day 1 and Day 15 of the injection. The safety and tolerability of the OIS and TIS regimens were assessed via Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU-SERS) scores recorded on Day 15 of the injection. Results: At baseline, the rate of previous hospitalization was higher in the OIS group than in the TIS group (60.9% vs. 26.1%, p=0.037). YMRS scores on Day 15 (11.0 ± 5.7 vs. 16.6 ± 6.2, p=0.003) and UKU-SERS Psychiatric adverse effects score on Day 15 (4.4 ± 1.8 vs. 7.5 ± 3.2, p