Ascher-Svanum Haya, Nyhuis Allen W, Faries Douglas E, Kinon Bruce J, Baker Robert W, Shekhar Anantha
Eli Lilly and Company, Indianapolis, IN 46285, USA.
Schizophr Bull. 2008 Nov;34(6):1163-71. doi: 10.1093/schbul/sbm134. Epub 2007 Dec 21.
Early nonresponse to antipsychotics appears to predict subsequent nonresponse to treatment when assessed in randomized controlled trials of predominately acute inpatients treated for schizophrenia. This study assessed the predictive accuracy of early nonresponse to treatment and its clinical, functional, and economic ramifications in the naturalistic treatment of predominately chronic outpatients treated for schizophrenia.
This post hoc analysis used data from a 1-year, randomized, open-label study of olanzapine, risperidone, and typical antipsychotics in the treatment of schizophrenia. If clinically warranted, patients could switch antipsychotics following 8 weeks of treatment. Patients completing 8 weeks of treatment (n = 443 of 664 enrollees) were included. Patients with early response (> or = 20% improvement from baseline on the Positive and Negative Syndrome Scale at 2 weeks) were compared with early nonresponders on symptom remission, functionality, perceptions of medication influence, and total health care costs at 8 weeks.
Early response/nonresponse at 2 weeks predicted subsequent response/nonresponse at 8 weeks with a high level of accuracy (72%) and specificity (89%). After 8 weeks, early nonresponders were less likely to achieve symptom remission (P < .001), improved less on functional domains (P < .05), perceived medication as less beneficial (P = .004), and incurred total heath care costs over twice that of early responders ($4349 vs $2102, P = .010).
In the usual care of schizophrenia patients, early nonresponse appears to reliably predict subsequent nonresponse to continued treatment with the same medication to be associated with poorer outcomes and higher health care costs. Identifying early nonresponders may minimize prolonging exposure to suboptimal or ineffective treatment strategies.
在以精神分裂症急性住院患者为主的随机对照试验中，抗精神病药物早期无反应似乎可预测后续治疗无反应。本研究评估了在以精神分裂症慢性门诊患者为主的自然治疗中，早期治疗无反应的预测准确性及其临床、功能和经济影响。
本事后分析使用了一项为期1年的随机、开放标签研究的数据，该研究比较了奥氮平、利培酮和传统抗精神病药物治疗精神分裂症的效果。如果临床需要，患者在治疗8周后可更换抗精神病药物。纳入完成8周治疗的患者（664名入组患者中的443名）。将早期有反应者（2周时阳性和阴性症状量表评分较基线改善≥20%）与早期无反应者在8周时的症状缓解情况、功能状态、对药物影响的认知以及总医疗费用方面进行比较。
2周时的早期反应/无反应以较高的准确性（72%）和特异性（89%）预测了8周时的后续反应/无反应。8周后，早期无反应者更不易实现症状缓解（P<.001），功能领域改善较少（P<.05），认为药物益处较小（P=.004），且总医疗费用是早期有反应者的两倍多（4349美元对2102美元，P=.010）。
在精神分裂症患者的常规治疗中，早期无反应似乎可可靠地预测后续对继续使用同一药物治疗无反应，且与较差的结局和较高的医疗费用相关。识别早期无反应者可尽量减少暴露于次优或无效治疗策略的时间。
