Karagianis Jamie, Williams Richard, Davis Lori, Procyshyn Ric, Monga Neerav, Hanley James, Chandrasena Ranjith, Thakur Aruna, Dickson Ruth
Eli Lilly Canada Inc, Toronto, ON, Canada.
Curr Med Res Opin. 2009 Sep;25(9):2121-32. doi: 10.1185/03007990903102966.
The Health Outcomes of a Canadian Community Cohort (HOCCC) study is a 1-year prospective observational study of outpatients with schizophrenia or related psychotic disorders. The purpose of the study was to compare effectiveness of antipsychotic treatment as measured by 1-year treatment completion rates.
Patients (N = 929) were enrolled if in the course of usual clinical practice they switched to a second-generation antipsychotic (SGA). Observational data were collected for up to 1 year. The primary analysis compared 1-year treatment-completion rates for the olanzapine cohort with the other SGA cohort (quetiapine, risperidone, clozapine), using a chi-squared test.
Of 929 patients enrolled, 64.8% (516/796) of evaluable patients completed 1 year of treatment. There was no statistically significant difference in the proportion of treatment completers between the olanzapine cohort (67.4%, 256/380) and the other SGA cohort (62.5%, 260/416). Treatment-completion rates were risperidone 62.0% (127/205), quetiapine 63.7% (123/193) and clozapine 55.6% (10/18). Antipsychotic polypharmacy was common. Patients treated with olanzapine or risperidone had significantly higher increases in BMI than quetiapine-treated patients. There were no major differences between olanzapine monotherapy and pooled other SGA monotherapy groups in status of extrapyramidal symptoms from baseline to endpoint.
Olanzapine and other SGAs exhibited similar rates of 1-year treatment completion. Further study of medication combinations is needed, given their perceived clinical value, and the high frequency of antipsychotic polypharmacy in clinical practice.
As most patients received several psychotropics and power was reduced in monotherapy analyses, comparisons between cohorts must be interpreted cautiously. Comparisons between individual antipsychotics were post hoc and not powered a priori. Accuracy and completeness of adverse event information for drugs other than olanzapine is limited.
加拿大社区队列健康结局（HOCCC）研究是一项针对精神分裂症或相关精神障碍门诊患者的为期1年的前瞻性观察性研究。该研究的目的是通过1年治疗完成率来比较抗精神病药物治疗的有效性。
如果患者在常规临床实践中改用第二代抗精神病药物（SGA），则纳入研究（N = 929）。收集长达1年的观察数据。主要分析使用卡方检验比较奥氮平队列与其他SGA队列（喹硫平、利培酮、氯氮平）的1年治疗完成率。
在纳入的929例患者中，64.8%（516/796）的可评估患者完成了1年治疗。奥氮平队列（67.4%，256/380）和其他SGA队列（62.5%，260/416）之间的治疗完成者比例无统计学显著差异。治疗完成率分别为：利培酮62.0%（127/205）、喹硫平63.7%（123/193）、氯氮平55.6%（10/18）。联合使用抗精神病药物很常见。与喹硫平治疗的患者相比，接受奥氮平或利培酮治疗的患者体重指数（BMI）显著增加更多。从基线到终点，奥氮平单药治疗组与其他SGA单药治疗组联合后的锥体外系症状状况无重大差异。
奥氮平和其他SGA的1年治疗完成率相似。鉴于药物组合在临床中的潜在价值以及临床实践中联合使用抗精神病药物的高频率，需要对药物组合进行进一步研究。
由于大多数患者接受了多种精神药物治疗，且单药治疗分析的效能降低，因此各队列之间的比较必须谨慎解释。个体抗精神病药物之间的比较是事后分析，且事先未设定效能。奥氮平以外药物不良事件信息的准确性和完整性有限。
