Shajahan Polash, Keith Sonia, Majjiga Chetan, Murphy Jennifer, MacRae Alison, Bashir Muhammad, Taylor Mark
NHS Lanarkshire, The Airbles Road Centre, Motherwell, Scotland, UK.
J Clin Psychiatry. 2009 May;70(5):692-8. doi: 10.4088/jcp.08m04177. Epub 2009 Mar 10.
Naturalistic studies offer advantages over randomized clinical trials by including patients seen in routine practice. Aripiprazole and quetiapine are the most recent second-generation antipsychotics available in the United Kingdom. We aimed to study all patients who were prescribed these medications in a defined geographic area in order to identify and compare those who had a good clinical response.
We conducted an electronic chart review of a sample of all people attending secondary mental health care in the county of Lanarkshire, Scotland, who were treated with aripiprazole or quetiapine for schizophrenia and related psychoses (ICD-10 criteria) between 2002 and 2007. To measure effectiveness, we retrospectively assigned Clinical Global Impressions (CGI) scores and examined medication discontinuation rates.
Eighty-nine patients were started on treatment with aripiprazole and 132 patients with quetiapine over the 5-year period. Those treated with quetiapine had a higher initial illness severity (CGI-Severity of Illness scale) (p = .0003), were more likely to be starting rather than switching antipsychotics (p = .0003), were more likely to have a mood disorder (p = .03), were less likely to be treatment resistant (p = .005), and had lower rates of prescription of additional antipsychotics (p = .009). After adjusting for these variables, the proportions who improved according to CGI were 74% with aripiprazole and 67% with quetiapine. Overall medication discontinuation rates were also similar, 42% for aripiprazole and 45% for quetiapine, with early discontinuation of aripiprazole being noticeable, often due to agitation (13% of all patients treated with the drug).
Despite their different pharmacologic properties, aripiprazole and quetiapine were similarly effective in the majority of patients. Early discontinuation of aripiprazole due to agitation was an important finding.
自然主义研究相较于随机临床试验具有优势，因为其纳入了常规诊疗中所见到的患者。阿立哌唑和喹硫平是英国最新可用的第二代抗精神病药物。我们旨在研究在一个特定地理区域内所有开具了这些药物的患者，以识别并比较那些有良好临床反应的患者。
我们对苏格兰拉纳克郡所有接受二级精神卫生保健且在2002年至2007年间使用阿立哌唑或喹硫平治疗精神分裂症及相关精神病（依据国际疾病分类第十版标准）的人员样本进行了电子病历回顾。为衡量疗效，我们回顾性地赋予临床总体印象（CGI）评分并检查药物停用率。
在这5年期间，89名患者开始使用阿立哌唑治疗，132名患者开始使用喹硫平治疗。接受喹硫平治疗的患者初始疾病严重程度更高（CGI疾病严重程度量表）（p = 0.0003），更有可能是开始而非换用抗精神病药物（p = 0.0003），更有可能患有心境障碍（p = 0.03），更不容易产生治疗抵抗（p = 0.005），并且额外抗精神病药物的处方率更低（p = 0.009）。在对这些变量进行调整后，依据CGI显示病情改善的比例，使用阿立哌唑的为74%，使用喹硫平的为67%。总体药物停用率也相似，阿立哌唑为42%，喹硫平为45%，阿立哌唑的早期停用较为明显，通常是由于激越（在所有接受该药物治疗的患者中占13%）。
尽管阿立哌唑和喹硫平具有不同的药理特性，但在大多数患者中它们的疗效相似。因激越导致阿立哌唑早期停用是一项重要发现。
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