Personalizing Antipsychotic Treatment of Schizophrenia

Monitoring Plasma Levels for Improved Treatment Decisions

by Marcela Horvitz-Lennon, Zachary Predmore, Soeren Mattke

Download Free Electronic Document

FormatFile SizeNotes
PDF file 0.2 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Despite the availability of efficacious antipsychotic drugs, the pharmacological management of schizophrenia remains a challenge, and it largely follows a trial-and-error paradigm. With notoriously high rates of poor antipsychotic drug adherence and limited means to detect it, prescribers are often uncertain whether a lack of treatment response is due to poor adherence or true lack of effect. Moreover, when encountering a patient with intolerable side effects, prescribers do not know whether to switch to another drug or merely reduce the dose. This uncertainty results in unnecessarily high rates of unwarranted treatment changes and antipsychotic polypharmacy, loss of adherence and disease control, and ultimately poor patient and societal outcomes. In this Perspective, we argue that point-of-care information on antipsychotic plasma levels — the amount of drug circulating in the patient's blood — will result in better patient care, which should lead to better health and better value for the health care system. While tests for antipsychotic plasma levels have long been available through specialized labs, they are not routinely used, in part because of delays in obtaining results. Access to information on antipsychotic plasma levels at the point of care would facilitate better use of currently available drugs and reduce the uncertainty associated with the management of complicated presentations by providing prescribers with a tool to "personalize" treatment to patients' characteristics, including responsiveness to specific medications, metabolism, and adherence behavior.

This research was sponsored by Janssen Diagnostics and conducted within RAND Health Advisory Services, the consulting practice of RAND Health.

This report is part of the RAND Corporation perspective series. RAND perspectives present informed perspective on a timely topic that address the challenges facing the public and private sectors. All RAND perspectives undergo rigorous peer review to ensure high standards for research quality and objectivity.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.