Tandon R, Jibson M D
University of Michigan Hospital, 1500 E Medical Center Drive, Department of Psychiatry, UH9C/9150, Ann Arbor, MI 48109-0120, USA.
Psychoneuroendocrinology. 2003 Jan;28 Suppl 1:9-26. doi: 10.1016/s0306-4530(02)00110-5.
The advent of the newer 'atypical' antipsychotic medications has revolutionized the pharmacologic treatment of schizophrenia and other psychotic disorders. In contrast to the older conventional antipsychotic agents, atypical medications have a broader spectrum of efficacy (greater efficacy in negative, cognitive, and mood symptoms) and a lower risk of extrapyramidal symptoms (EPS) and tardive dyskinesia. Due to concerns surrounding hematological safety and other adverse effects, clozapine is used principally in patients refractory to treatment with other antipsychotic agents. The other three universally available atypical agents (risperidone, olanzapine, and quetiapine) collectively constitute about 70% of all antipsychotic prescriptions in the USA. Despite the broad popularity of these medications and their rapid adoption in general clinical practice, there are limited data on how they compare to each other with regards to their overall efficacy and also as to their efficacy in specific symptom domains. To address this question, two separate analyses were undertaken. First, all published, short-term, randomized, controlled clinical trials of these agents in schizophrenia and schizoaffective disorder were reviewed and the extent of improvement across these agents was compared. While the amount of improvement with a particular agent across its different studies varied, the average improvement was similar for the agents for all efficacy parameters considered. Secondly, all randomized, controlled clinical trials directly comparing two or more of these agents in patients with schizophrenia or schizoaffective disorder were analyzed. Only three such trials (all industry sponsored) were identified; while there were differences in methodology and small differences in efficacy on a minority of measures on which comparisons were undertaken, the preponderance of data suggested no differences in efficacy. While data thus far do not support assertions of differential efficacy between risperidone, olanzapine, and quetiapine, there are clear differences in their side-effect profiles and these are briefly summarized.
新型“非典型”抗精神病药物的出现彻底改变了精神分裂症和其他精神病性障碍的药物治疗。与传统的老一代抗精神病药物相比，非典型药物具有更广泛的疗效谱（对阴性、认知和情绪症状有更高疗效），且锥体外系症状（EPS）和迟发性运动障碍的风险更低。由于对血液学安全性和其他不良反应的担忧，氯氮平主要用于对其他抗精神病药物治疗无效的患者。其他三种普遍可用的非典型药物（利培酮、奥氮平和喹硫平）在美国所有抗精神病药物处方中合计约占70%。尽管这些药物广受欢迎并迅速被广泛应用于临床实践，但关于它们在总体疗效以及特定症状领域的疗效方面如何相互比较的数据有限。为解决这个问题，进行了两项独立分析。首先，回顾了所有已发表的、关于这些药物治疗精神分裂症和分裂情感性障碍的短期、随机、对照临床试验，并比较了这些药物的改善程度。虽然特定药物在不同研究中的改善程度有所不同，但在所考虑的所有疗效参数方面，这些药物的平均改善情况相似。其次，分析了所有直接比较两种或更多种此类药物治疗精神分裂症或分裂情感性障碍患者的随机、对照临床试验。仅确定了三项此类试验（均由制药行业赞助）；虽然在方法上存在差异，且在少数进行比较的测量指标上疗效存在细微差异，但大量数据表明疗效无差异。虽然目前的数据不支持利培酮、奥氮平和喹硫平在疗效上存在差异的说法，但它们的副作用谱存在明显差异，现简要总结如下。
