Liu-Seifert Hong, Adams David H, Kinon Bruce J
Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA.
BMC Med. 2005 Dec 23;3:21. doi: 10.1186/1741-7015-3-21.
Stopping antipsychotic treatment can interrupt improvement and exacerbate the illness. The reasons for discontinuing treatment during controlled clinical trials were analyzed to explore this phenomenon.
A post-hoc, pooled analysis was made of 4 randomized, double-blind clinical trials, 24-28 weeks in duration, involving 1627 patients with schizophrenia or a related disorder. Analyses combined all the atypical antipsychotic treatment groups in the studies.
The majority of patients (53%) stopped their treatment at an early stage. Poor psychiatric response along with worsening symptoms was the most frequently given reason for discontinuing the course (36%), which was substantially more common than discontinuation due to poor tolerability of the medication (12%). This phenomenon was corroborated by less improvement in patients who discontinued treatment compared with those who completed, based on the PANSS total scores. Discontinuation due to poor response was, apparently, more predominantly linked to patient perception than to physicians' conclusions alone (80% vs. 20%). Discontinuation due to patient perception of poor response appeared to occur particularly early in the course of treatment. Patients who discontinued due to poor toleration of the medication responded in a more comparable manner with completers.
Discontinuing treatment may lead to exacerbation of symptoms, undermining therapeutic progress. In these studies, poor response to treatment and worsening of underlying psychiatric symptoms, and to a lesser extent, intolerability to medication were the primary contributors to treatment being discontinued. Our findings suggest that adherence may be enhanced by effective symptom control, as objectively measured and as subjectively perceived. Such strategies may improve patients' willingness to undertake long-term therapy and increase the likelihood of a better prognosis.
停用抗精神病药物治疗可能会中断病情改善并使疾病恶化。分析了在对照临床试验期间停药的原因以探究这一现象。
对4项为期24 - 28周的随机双盲临床试验进行事后汇总分析，涉及1627例精神分裂症或相关障碍患者。分析合并了研究中的所有非典型抗精神病药物治疗组。
大多数患者（53%）在早期就停止了治疗。精神症状反应不佳以及症状恶化是最常给出的停药原因（36%），这比因药物耐受性差而停药（12%）要常见得多。基于阳性和阴性症状量表（PANSS）总分，与完成治疗的患者相比，停药患者的病情改善较少，这证实了这一现象。因反应不佳而停药显然更多地与患者的感知有关，而不仅仅与医生的判断有关（80%对20%）。因患者感觉反应不佳而停药似乎尤其在治疗过程早期发生。因药物耐受性差而停药的患者与完成治疗的患者反应更相似。
停药可能导致症状恶化，破坏治疗进展。在这些研究中，对治疗反应不佳和潜在精神症状恶化，以及在较小程度上对药物不耐受是导致停药的主要原因。我们的研究结果表明，通过客观测量和主观感知的有效症状控制可以提高依从性。此类策略可能会提高患者接受长期治疗的意愿，并增加预后更好的可能性。
