Genç Yasin, Taner Ender, Candansayar Selcuk
Department of Psychiatry, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey.
Adv Ther. 2007 Jan-Feb;24(1):1-13. doi: 10.1007/BF02849987.
Schizophrenia is a devastating psychiatric disorder. Clozapine has long been the gold standard for treatment of patients with treatment-resistant schizophrenia; however, some patients are only partially responsive to clozapine treatment. Augmentation of clozapine treatment might enhance its effectiveness in partial responders, but only a few studies have investigated possible augmentation strategies. This study compared the effectiveness and tolerability of the combination of amisulpride and clozapine with the combination of quetiapine and clozapine in patients who were only partially responsive to clozapine monotherapy. Fifty-six treatment-resistant patients who were partially responsive to clozapine were randomly assigned to receive amisulpride or quetiapine along with an ongoing stable dose of clozapine. Fifty patients completed the study. Patients were evaluated at baseline and at the first, third, sixth, and eighth weeks. Efficacy measures consisted of the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), and the Clinical Global Impression (CGI) scale. Tolerability and adverse effects were assessed with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and the Simpson Angus Scale (SAS). A substantial improvement occurred in both groups by the end of the eighth week; however, the improvement associated with amisulpride was significantly greater than that seen with quetiapine. This difference was noted as early as the third week of follow-up in terms of CGI scores, and by the sixth week with regard to BPRS, SANS, and SAPS scores. Both drugs were well tolerated, as measured by UKU and SAS. Improvement favoring clozapine+amisulpride could be attributed to the selective D2/D3 binding property of amisulpride, which had an additional effect in improving symptoms of schizophrenia. The authors concluded that amisulpride seems to be effective and well tolerated for augmentation purposes in clozapine-resistant patients.
精神分裂症是一种极具破坏性的精神障碍。氯氮平长期以来一直是治疗难治性精神分裂症患者的金标准；然而，一些患者对氯氮平治疗仅部分有反应。增加氯氮平治疗可能会提高其对部分反应者的有效性，但仅有少数研究探讨了可能的增效策略。本研究比较了氨磺必利与氯氮平联合用药和喹硫平与氯氮平联合用药在仅对氯氮平单药治疗部分有反应的患者中的有效性和耐受性。56例对氯氮平部分有反应的难治性患者被随机分配接受氨磺必利或喹硫平以及持续稳定剂量的氯氮平。50例患者完成了研究。在基线以及第1、3、6和8周对患者进行评估。疗效指标包括简明精神病评定量表（BPRS）、阴性症状评定量表（SANS）、阳性症状评定量表（SAPS）和临床总体印象（CGI）量表。使用临床研究不良反应量表（UKU）和辛普森安格斯量表（SAS）评估耐受性和不良反应。到第8周结束时，两组均有显著改善；然而，与氨磺必利相关的改善明显大于喹硫平。早在随访第3周时，就CGI评分而言就注意到了这种差异，到第6周时，就BPRS、SANS和SAPS评分而言也注意到了这种差异。根据UKU和SAS测量，两种药物耐受性良好。氯氮平加氨磺必利的改善可能归因于氨磺必利的选择性D2/D3结合特性，其在改善精神分裂症症状方面有额外作用。作者得出结论，氨磺必利似乎对氯氮平抵抗患者的增效治疗有效且耐受性良好。
