治疗方案的自然主义研究结果：更换非典型抗精神病药物或用丙戊酸盐增效。

Results of a naturalistic study of treatment options: switching atypical antipsychotic drugs or augmenting with valproate.

作者信息

Cramer Joyce A, Sernyak Michael

机构信息

Department of Psychiatry, Yale University School of Medicine, New Haven, USA.

出版信息

Clin Ther. 2004 Jun;26(6):905-14. doi: 10.1016/s0149-2918(04)90134-8.

DOI:10.1016/s0149-2918(04)90134-8

PMID:15262461

Abstract

BACKGROUND

Combination therapy with atypical antipsychotic agents has not been well studied. Duration of persistence with a prescribed treatment regimen can be used to estimate overall treatment success.

OBJECTIVE

The aim of this study was to determine whether valproate augmentation improved treatment efficacy (ie, persistence with the prescribed regimen) and efficacy (ie, reduction of antipsychotic dose) with atypical antipsychotic drugs for older and younger patients, using a retrospective database analysis.

METHODS

Prescription refill data for atypical antipsychotics during calendar-year 2001 from a national pharmacy chain was used for longitudinal analyses. The database was used to identify patients aged 15 to 64 years and > or =65 years taking risperidone, quetiapine, or olanzapine (but not valproate). Patients who switched to another atypical antipsychotic (group A) or added valproate (group B) were followed after the index prescription to determine the duration of persistence with the treatment regimen and dose changes.

RESULTS

We identified 10,262 patients who were prescribed an atypical antipsychotic, of whom 1022 patients switched to an alternative atypical and 1651 added valproate to the index atypical. The addition of valproate provided significantly longer duration of treatment regimen (mean, 155-159 days) than switching from any atypical antipsychotic drug (mean, 127-130 days) for patients aged 15 to 64 years or > or =65 years (all P<0.001). Atypical antipsychotic doses did not change significantly from baseline to final prescription in groups A or B. The final mean (SD) dose of valproate added to risperidone (389.1 [130.7] mg/d) was significantly lower than valproate added to quetiapine (424.6 [117.1] mg/d; P=0.002) or olanzapine (411.6 [122.8] mg/d; P=0.007).

CONCLUSIONS

In this naturalistic study, the addition of valproate to an atypical antipsychotic increased the duration of treatment compared with switching among atypical antipsychotics. Valproate augmentation may be a good treatment strategy for patients whose atypical antipsychotic monotherapy is inadequate.

摘要

背景

非典型抗精神病药物的联合治疗尚未得到充分研究。规定治疗方案的持续时间可用于评估总体治疗效果。

目的

本研究旨在通过回顾性数据库分析，确定丙戊酸盐增效是否能提高老年和年轻患者使用非典型抗精神病药物的治疗效果（即坚持规定治疗方案）和疗效（即降低抗精神病药物剂量）。

方法

使用来自一家全国性连锁药店的2001年日历年非典型抗精神病药物的处方再填充数据进行纵向分析。该数据库用于识别年龄在15至64岁以及≥65岁且正在服用利培酮、喹硫平或奥氮平（但未服用丙戊酸盐）的患者。在索引处方后，对转而使用另一种非典型抗精神病药物的患者（A组）或添加丙戊酸盐的患者（B组）进行随访，以确定治疗方案的持续时间和剂量变化。

结果

我们识别出10262名被处方使用非典型抗精神病药物的患者，其中1022名患者转而使用另一种非典型抗精神病药物，1651名患者在索引非典型抗精神病药物基础上加用了丙戊酸盐。对于15至64岁或≥65岁的患者，添加丙戊酸盐的治疗方案持续时间（平均155 - 159天）显著长于从任何一种非典型抗精神病药物转换治疗的持续时间（平均127 - 130天）（所有P<0.001）。A组或B组从基线到最终处方时，非典型抗精神病药物剂量均无显著变化。添加到利培酮中的丙戊酸盐最终平均（标准差）剂量（389.1[130.7]mg/d）显著低于添加到喹硫平中的丙戊酸盐（424.6[117.1]mg/d；P = 0.002）或奥氮平中的丙戊酸盐（411.6[122.8]mg/d；P = 0.007）。