Feldman Peter D, Kaiser Christopher J, Kennedy John S, Sutton Virginia K, Tran Pierre V, Tollefson Gary D, Zhang Fan, Breier Alan
Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
J Clin Psychiatry. 2003 Sep;64(9):998-1004. doi: 10.4088/jcp.v64n0904.
This analysis compares the efficacy of risperidone and olanzapine in controlling negative and positive symptoms of chronic psychosis in older patients.
Post hoc assessments were made in a subset of risperidone-treated (N = 19) and olanzapine-treated (N = 20) older patients (aged 50 to 65 years) from a large international, multicenter, parallel, double-blind, 28-week study of patients aged 18 to 65 years (N = 339) randomly assigned to receive risperidone (4-12 mg/day) or olanzapine (10-20 mg/day). Assessments were made using repeated-measures analysis.
At both 8 weeks and 28 weeks, the magnitude of changes in Positive and Negative Syndrome Scale (PANSS) positive symptom subscale scores did not differ between treatment groups (8 weeks: risperidone, -6.5; olanzapine, -6.8, p = .866; 28 weeks: risperidone, -6.5; olanzapine, -7.0; p = .804). However, by the 8-week timepoint, olanzapine had reduced PANSS negative subscale scores significantly more than risperidone (-8.8 vs. -4.9, p = .032). By the 28-week endpoint, olanzapine had continued to maintain significantly greater reduction in baseline-to-endpoint PANSS negative scores (-8.1 vs. -3.5, p = .032) and led to significantly greater reduction in scores on the Scale for the Assessment of Negative Symptoms (SANS) dimensions of affective flattening (-5.2 vs. -0.6, p = .033) and alogia (-3.8 vs. -0.3, p = .007). Patients in the olanzapine treatment group also demonstrated numerically greater reduction of both SANS summary (-3.7 vs. -1.0, p = .078) and SANS composite scores (-14.1 vs. -4.1, p = .075).
These data demonstrate that, in older patients with schizophrenia and related psychotic disorders, risperidone and olanzapine have approximately equal efficacy in controlling positive symptoms. However, olanzapine appears to be more efficacious in maintaining control over negative symptoms.
本分析比较了利培酮和奥氮平在控制老年患者慢性精神病阴性和阳性症状方面的疗效。
对来自一项针对18至65岁患者（N = 339）的大型国际多中心平行双盲28周研究中的一个亚组进行事后评估，该亚组包括接受利培酮治疗（N = 19）和奥氮平治疗（N = 20）的老年患者（年龄50至65岁），这些患者被随机分配接受利培酮（4 - 12毫克/天）或奥氮平（10 - 20毫克/天）治疗。使用重复测量分析进行评估。
在8周和28周时，治疗组之间阳性和阴性症状量表（PANSS）阳性症状子量表得分的变化幅度没有差异（8周时：利培酮，-6.5；奥氮平，-6.8，p = 0.866；28周时：利培酮，-6.5；奥氮平，-7.0；p = 0.804）。然而，到8周时间点时，奥氮平使PANSS阴性子量表得分降低的幅度明显大于利培酮（-8.8对-4.9，p = 0.032）。到28周终点时，奥氮平在基线至终点的PANSS阴性得分方面继续保持显著更大幅度的降低（-8.1对-3.5，p = 0.032），并导致情感平淡（-5.2对-0.6，p = 0.033）和言语贫乏（-3.8对-0.3，p = 0.007）等阴性症状评估量表（SANS）维度得分有显著更大幅度的降低。奥氮平治疗组的患者在SANS总分（-3.7对-1.0，p = 0.078）和SANS综合得分（-14.1对-4.1，p = 0.075）方面也在数值上有更大幅度的降低。
这些数据表明，在患有精神分裂症及相关精神障碍的老年患者中，利培酮和奥氮平在控制阳性症状方面疗效大致相当。然而，奥氮平在维持对阴性症状的控制方面似乎更有效。
