Absence of distress through relief of symptoms is not the same as the presence of wellbeing, emphasized Ilaria Cuomo (La Sapienza University, Rome, Italy), who set the scene for the discussion of unmet needs and how clinicians are adopting a more patient-centric approach.
For patients with schizophrenia, quality of life and functional recovery are key treatment goals at all stages of the disease, she said.1,2 Similarly in MDD, the optimum outcome is not only full symptomatic recovery but also improved functioning and quality of life.3
Understanding the patient perspective is now more prominent, with increased emphasis on restoring functioning 4,5
As part of this process, there is growing interest in the concept of patient engagement. This is different from the idea of engagement with therapy, as in adherence. It is a far broader concept that includes life fulfillment, well-being and participation in daily activities.6
In this new sense, engagement is regarded as having four domains: 6
- cognitive -- concentration and decision making
- emotional -- including a person’s view of themselves and their future, and capacity for pleasure and enjoyment
- social -- encompassing interpersonal sensitivity and interest; and
- physical -- having energy and not feeling slowed down.
Recent studies have shown that we can measure engagement using subscales derived from existing, well-used measures.6,7
In both MDD and schizophrenia, an oral D2 receptor partial agonist with balanced receptor binding profile brought greater patient engagement than placebo
The engagement subscales were proposed to capture patient well-being and engagement beyond the core symptoms of depression or schizophrenia. In the case of depression, 10 items of the Inventory for Depressive Symptomatology (IDS) were selected by an expert panel.6 In the case of schizophrenia, 11 items of the Positive and Negative Syndrome Scale (PANSS) were identified by a group of specialists.7
Improved engagement with adjunctive MDD treatment
In MDD patients on antidepressant therapy, the engagement subscale is sensitive to the beneficial effects of adjunctive treatment with an oral D2 receptor partial agonist with balanced receptor binding profile .8
In pooled data from three pivotal studies, 8 of 10 items in the engagement subscale showed significantly greater improvement from baseline to week 6 in patients taking antidepressant plus adjunctive antipsychotic therapy than in those taking antidepressant plus placebo, Professor McIntyre reported.
These pooled data also suggest that improved patient functioning is closely associated with improved patient engagement.8
MDD patients who responded -- according to their improved engagement -- showed significantly greater reductions from baseline on the Sheehan Disability Scale overall and in the three component domains of work/school, social and family life.
Responders in terms of engagement had greater reductions in disability
Improved engagement also seen in schizophrenia
In schizophrenia, the picture is similar.9 A post-hoc analysis of data from the three pivotal placebo-controlled studies of the oral D2 receptor partial agonist with balanced receptor binding profile suggests that active treatment brings greater engagement.
On 10 of 11 items in the engagement subscale, patients on antipsychotic therapy showed greater improvement from baseline to week 6 than was seen in patients randomized to placebo. Responders in terms of engagement had greater improvement on the Personal and Social Performance Scale.
Response rates for engagement (defined by an improvement of 5 points or more from baseline on the relevant subscales) were significantly higher with active treatment than with placebo in both schizophrenia (44% vs31.1%)9 and MDD (37.7 vs 26.2%).8
Patient centric functional recovery and quality of life are key treatment goals
Educational financial support for this satellite symposium at ECNP Virtual 2020 was provided by Otsuka Pharmaceutical Europe Ltd and H. Lundbeck A/S