{"id":59676,"date":"2015-09-03T10:16:37","date_gmt":"2015-09-03T14:16:37","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=59676"},"modified":"2015-09-03T10:44:28","modified_gmt":"2015-09-03T14:44:28","slug":"how-many-stars","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/09\/03\/how-many-stars\/","title":{"rendered":"how many stars?&#8230;"},"content":{"rendered":"\n<ul>\n<div class=\"small\"><strong><font color=\"#200020\">pen&middot;ance<\/font><\/strong><\/div>\n<div class=\"small\">noun: penance; plural noun: penances<\/div>\n<ol><span class=\"small\">         <\/p>\n<li>\n<div align=\"justify\">voluntary self-punishment inflicted as an outward expression of repentance for having done wrong.<\/div>\n<div>&quot;he had done public penance for those hasty words&quot;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">a Christian sacrament in which a member of the Church confesses sins to a priest and is given absolution.<\/div>\n<\/li>\n<p>       <\/span>   <\/ol>\n<\/ul>\n<div align=\"justify\" class=\"small\">At the first of the month, I usually scan the major journals. I think I do it as penance for having stopped reading them altogether in the latter part of my practice years. I have the likely irrational idea that if I and the rest of psychiatry had insisted that our journals maintained some kind of standard, maybe we could have short-circuited some of what happened over the last couple of decades.        <\/div>\n<p>     <\/p>\n<div align=\"justify\" class=\"small\">This month, the second article was an editorial about a new Atypical Antipsychotic, <font color=\"#200020\">Brexpiprazole<\/font>. I&#8217;d read about half of it when I realized I already knew it, because I&#8217;d written about it when the article in this issue was published in advance on-line back in April [<a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/04\/22\/the-spice-must-flow-2\/\"><em>the spice must flow&hellip;<\/em><\/a>]. I&#8217;d forgotten the name. This editorial ends with:<\/div>\n<blockquote>\n<div align=\"justify\">&#8230;In summary, as we learned from the CATIE study, we will not know with any certainty how a new antipsychotic compares with other agents currently on the market until more comparative data are available, ideally from head-to-head randomized trials. This information is important not only to justify the higher cost compared with generic agents but also to guide shared decision making. It is an appealing notion that a clinician could select from a collection of D2 partial agonists with a range of intrinsic activities the agent most suitable for an individual patient on the basis of sensitivity to side effects and efficacy requirements. Is a patient likely to experience a Goldilocks response and find brexpiprazole to be &ldquo;just right&rdquo; after disappointing experiences with aripiprazole and D2 antagonists? Possibly, but it&rsquo;s not clear that the space that brexpiprazole occupies between aripiprazole and D2 antagonist antipsychotics is wide enough to be clinically relevant; whether brexpiprazole will differentiate itself from other agents in head-to-head comparisons or in clinical practice remains to be seen.<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">Before I looked at the article about the Clinical Trial [that I&#8217;d&nbsp; already reported on], I tried to recall what I&#8217;d thought when I wrote about it earlier. I remembered that it was a ghost-written, industry-funded RCT with only one academic KOL author and a slew of company authors. I recalled that it was conducted over 60 sites and that the drug itself was an Abilify clone:<\/div>\n<div align=\"center\" class=\"small\"><img decoding=\"async\" width=\"180\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/abilify-15.gif\" \/><\/div>\n<div align=\"justify\" class=\"small\">I remembered nothing about the drug itself:    <\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_self\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25882325\">Efficacy  and Safety of Brexpiprazole for the Treatment of Acute Schizophrenia: A  6-Week Randomized, Double-Blind, Placebo-Controlled Trial<\/a><\/div>\n<div align=\"center\" class=\"small\">by <strong><font color=\"#990000\">Correll CU<\/font><\/strong>,<strong><font color=\"#0033ff\"> Skuban A<\/font><\/strong>,<strong><font color=\"#0033ff\"> Ouyang J<\/font><\/strong>,<strong><font color=\"#0033ff\"> Hobart M<\/font><\/strong>,<strong><font color=\"#0033ff\"> Pfister S<\/font><\/strong>,<strong><font color=\"#0033ff\"> McQuade RD<\/font><\/strong>,<strong><font color=\"#0033ff\"> Nyilas M<\/font><\/strong>,<strong><font color=\"#0033ff\"> Carson WH<\/font><\/strong>,<strong><font color=\"#0033ff\"> Sanchez R<\/font><\/strong>,<strong><font color=\"#0033ff\"> and Eriksson H.<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\"><strong><font color=\"#004400\">American Journal of Psychiatry.<\/font><\/strong> 2015 172[9]:820-821. <\/div>\n<div align=\"center\" class=\"middle\">[<a href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01396421\" target=\"_blank\">NCT01396421<\/a>]<\/div>\n<p>      <\/p>\n<div align=\"center\"><img decoding=\"async\" width=\"300\" border=\"1\" src=\"http:\/\/1boringoldman.com\/images\/brex-5.gif\" \/><\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">That post [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/04\/22\/the-spice-must-flow-2\/\"><em>the spice must flow&hellip;<\/em><\/a>] mentioned another companion on-line article that has since been published as well:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_self\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25682550\">A  multicenter, randomized, double-blind, controlled phase 3 trial of  fixed-dose brexpiprazole for the treatment of adults with acute  schizophrenia.<\/a><\/div>\n<div align=\"center\" class=\"small\">by <strong><font color=\"#990000\">Kane JM<\/font><\/strong>, <strong><font color=\"#0066ff\">Skuban<\/font><\/strong>, <strong><font color=\"#0066ff\">Ouyang<\/font><\/strong>, <strong><font color=\"#0066ff\">Hobart, Pfister<\/font><\/strong>, <strong><font color=\"#0066ff\">McQuade<\/font><\/strong>, <strong><font color=\"#0066ff\">Nyilas<\/font><\/strong>, <strong><font color=\"#0066ff\">Carson<\/font><\/strong>, <strong><font color=\"#0066ff\">Sanchez<\/font><\/strong>, <strong><font color=\"#0066ff\">and Eriksson<\/font><\/strong>.<\/div>\n<div align=\"center\" class=\"middle\"><strong><font color=\"#200020\">Schizophrenia Research.<\/font><\/strong> 2015 164[1-3]:127-35.<\/div>\n<div align=\"center\" class=\"middle\">[<a href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01393613\" target=\"_blank\">NCT01393613<\/a>]<\/div>\n<p>      <\/p>\n<div align=\"center\"><img decoding=\"async\" width=\"300\" border=\"1\" src=\"http:\/\/1boringoldman.com\/images\/brex-6.gif\" \/><\/div>\n<\/blockquote>\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"520\" border=\"0\" height=\"181\" src=\"http:\/\/1boringoldman.com\/images\/brex-7.gif\" \/><\/p>\n<p align=\"justify\" class=\"small\">I had found some other articles [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/12\/56760\/\">prelapse: prequel 1&hellip;<\/a>, <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/12\/prelapse-prequel2\/\">prelapse: prequel 2&hellip;<\/a>, and <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2015\/05\/12\/prelapse-but-theres-more\/\">prelapse: but there&rsquo;s more&hellip;<\/a>]. They were about the Long Acting Injectable versions of the Atypical Antipsychotics coming onto the market now that the drugs themselves have gone off-patent &#8211; one of which was an Abilify Injectable.<\/p>\n<hr width=\"75%\" size=\"1\" \/>\n<p align=\"justify\" class=\"small\">It&#8217;s not working &#8211; my doing penance. I&#8217;ve been doing the scan-the-journals thing for five or six years, and it hasn&#8217;t changed anything. These are just drug company advertisements, the roll out for an Abilify patent-extending campaign. The poor editorial writer could hardly find anything to say about <font color=\"#200020\">Brexpiprazole<\/font>. I can hardly think of anything to say about <font color=\"#200020\">Brexpiprazole<\/font>. These articles will make good handouts for the drug reps as they go from place to place trying to convince practitioners to prescribe <font color=\"#200020\">Brexpiprazole<\/font> [in patent] instead of Abilify [now in generics]. And &quot;yes&quot;, the RCTs are lined up for the full complement of indications [notice where the emphasis is]:<\/p>\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"342\" border=\"0\" height=\"129\" src=\"http:\/\/1boringoldman.com\/images\/brex-3.gif\" \/><\/p>\n<hr width=\"75%\" size=\"1\" \/>\n<p align=\"justify\" class=\"small\">I guess there are some things that have changed. They don&#8217;t hire on as many KOLs as they used to &#8211; just one per article. The ghost writers still haven&#8217;t made it to the author byline, but we immediately know that they&#8217;re there. And, for that matter, we didn&#8217;t used to even know it was industry funded. It was pretty easy to find the <a href=\"http:\/\/1boringoldman.com\/images\/brex-1.gif\" target=\"_blank\">Effect Sizes<\/a> and compare <font color=\"#200020\">Brexpiprazole<\/font> to the other Atypicals. I guess that&#8217;s progress of sorts. But it doesn&#8217;t change the fact that these are advertisements in a first-line psychiatric journal.&nbsp; <\/p>\n<div align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" hspace=\"4\" height=\"75\" align=\"left\" src=\"http:\/\/1boringoldman.com\/images\/brex-8.gif\" \/>So I needed a new counter-top Microwave Oven. I moved on to <strong><font color=\"#000001\">amazon.com<\/font><\/strong> and used the &quot;stars&quot; from other shoppers to make my selection. Maybe the <strong><font color=\"#004400\">American Journal of Psychiatry<\/font><\/strong> could institute something like that real soon. It would be easier than making somebody have to think up things to say in an editorial&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>pen&middot;ance noun: penance; plural noun: penances voluntary self-punishment inflicted as an outward expression of repentance for having done wrong. &quot;he had done public penance for those hasty words&quot; a Christian sacrament in which a member of the Church confesses sins to a priest and is given absolution. At the first of the month, I usually [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-59676","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/59676","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=59676"}],"version-history":[{"count":34,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/59676\/revisions"}],"predecessor-version":[{"id":59710,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/59676\/revisions\/59710"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=59676"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=59676"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=59676"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}