Dunayevich Eduardo, Ascher-Svanum Haya, Zhao Fangyi, Jacobson Jennie G, Phillips Glenn A, Dellva Mary Anne, Green Alan I
Outcomes Research, Eli Lilly and Co., Indianapolis, IN, USA.
J Clin Psychiatry. 2007 Aug;68(8):1163-71. doi: 10.4088/jcp.v68n0801.
Time to all-cause treatment discontinuation is considered a composite proxy measure of treatment efficacy, safety, and tolerability. Longer time to discontinuation of antipsychotic medication for any cause has been shown to be associated with greater symptom improvements in the treatment of schizophrenia. This study examines whether longer time to all-cause medication discontinuation is also linked to better functional outcomes.
Using pooled data from 4 randomized, double-blind antipsychotic trials of 24- to 28-weeks' duration, this study examined the association between time to all-cause treatment discontinuation and functional outcomes, as assessed by a disease-specific, clinician-rated measure (Quality of Life Scale [QLS]) and a generic, patient-reported measure (Medical Outcomes Study Short Form 36 [SF-36]). Patients in these trials had a DSM-IV diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder. This post hoc analysis used Pearson partial correlations to assess relationships between time to treatment discontinuation and changes in functional scores, adjusting for baseline scores. Repeated measures analyses were also conducted to compare post-baseline functional outcome change over time between completers and noncompleters.
Longer time to all-cause treatment discontinuation was found to be significantly associated with greater improvements in all assessed functional domains (p < .05). Patients who completed their respective trials (46.8%, 761/1627) experienced significantly greater improvement in functional outcome measures (in 4 QLS domains and SF-36 mental health component summary score; all, p < .001) compared to patients who discontinued for any cause. In addition, greater symptom improvement was significantly associated with greater functional improvements in assessed domains.
Findings from this post hoc analysis illustrate the importance of longer treatment duration with antipsychotics for improving functional outcomes in the treatment of patients with schizophrenia.
全因治疗停药时间被视为治疗效果、安全性和耐受性的综合替代指标。在精神分裂症治疗中，因任何原因停用抗精神病药物的时间越长，症状改善越明显。本研究旨在探讨全因药物停药时间延长是否也与更好的功能结局相关。
本研究使用了4项为期24至28周的随机、双盲抗精神病药物试验的汇总数据，通过特定疾病的临床医生评定量表（生活质量量表[QLS]）和通用的患者报告量表（医学结局研究简明健康调查问卷36[SF-36]）评估全因治疗停药时间与功能结局之间的关联。这些试验中的患者符合《精神疾病诊断与统计手册》第四版（DSM-IV）对精神分裂症、分裂样障碍或分裂情感性障碍的诊断标准。这项事后分析采用Pearson偏相关分析来评估治疗停药时间与功能评分变化之间的关系，并对基线评分进行了调整。还进行了重复测量分析，以比较完成者和未完成者在基线后功能结局随时间的变化。
发现全因治疗停药时间延长与所有评估的功能领域有更显著的改善相关（p < 0.05）。与因任何原因停药的患者相比，完成各自试验的患者（46.8%，761/1627）在功能结局指标上有更显著的改善（在4个QLS领域和SF-36心理健康分量表总分；均p < 0.001）。此外，症状改善越明显与评估领域的功能改善越大显著相关。
这项事后分析结果表明，延长抗精神病药物治疗时间对于改善精神分裂症患者的功能结局具有重要意义。
