精神分裂症患者自然主义治疗中对典型和非典型抗精神病药物的依从性和持续性。
Adherence and persistence to typical and atypical antipsychotics in the naturalistic treatment of patients with schizophrenia.
作者信息
Ascher-Svanum Haya, Zhu Baojin, Faries Douglas E, Lacro Jonathan P, Dolder Christian R, Peng Xiaomei
机构信息
Eli Lilly and Company, Outcomes Research, Indianapolis, IN, USA;
出版信息
Patient Prefer Adherence. 2008 Feb 2;2:67-77. doi: 10.2147/ppa.s2940.
OBJECTIVE
To compare adherence and persistence to typical versus atypical antipsychotics and between specific atypical agents in the usual care of schizophrenia and to examine the association between adherence and persistence.
METHOD
Data were drawn from a 3-year prospective, nonrandomized, noninterventional study of schizophrenia conducted during 1997-2003. Initiators on haloperidol, risperidone, olanzapine, quetiapine, and clozapine with at least 1 year of follow-up were included (n = 878). Adherence (Medication Possession Ratio, MPR) and persistence (time to all-cause medication discontinuation) were assessed using medical record prescription information. Analyses employed multivariate statistics adjusted for group differences.
RESULTS
Overall, 58% of the patients were deemed adherent (MPR >80%). Adherence rates were higher: for atypical (59.4%) than typical antipsychotics (34.5%, p < 0.001), for clozapine (77%) than each comparator excluding olanzapine (p < 0.01), and for olanzapine (64%) than risperidone (57%, p = 0.027) and quetiapine (52%, p = 0.019). Differences between risperidone and quetiapine were not statistically significant. Adherence and persistence were highly correlated (r = 0.957, p < 0.001).
CONCLUSION
In the usual care of schizophrenia, medication adherence and persistence appear to be highly correlated and to significantly differ between typical and atypical antipsychotics and among atypical agents. The choice of antipsychotic may play a meaningful role in patients' adherence to and persistence with antipsychotic medications.
目的
比较在精神分裂症常规治疗中，使用典型抗精神病药物与非典型抗精神病药物的依从性和持续性，并比较特定非典型药物之间的依从性和持续性，同时研究依从性与持续性之间的关联。
方法
数据来自于1997年至2003年进行的一项为期3年的精神分裂症前瞻性、非随机、非干预性研究。纳入了使用氟哌啶醇、利培酮、奥氮平、喹硫平和氯氮平且至少随访1年的起始用药者（n = 878）。使用病历处方信息评估依从性（药物持有率，MPR）和持续性（全因停药时间）。分析采用了针对组间差异进行调整的多变量统计方法。
结果
总体而言，58%的患者被认为具有依从性（MPR > 80%）。依从率更高：非典型抗精神病药物（59.4%）高于典型抗精神病药物（34.5%，p < 0.001），氯氮平（77%）高于除奥氮平之外的每种对照药物（p < 0.01），奥氮平（64%）高于利培酮（57%，p = 0.027）和喹硫平（52%，p = 0.019）。利培酮和喹硫平之间的差异无统计学意义。依从性与持续性高度相关（r = 0.957，p < 0.001）。
结论
在精神分裂症的常规治疗中，药物依从性和持续性似乎高度相关，且在典型和非典型抗精神病药物之间以及非典型药物之间存在显著差异。抗精神病药物的选择可能在患者对抗精神病药物的依从性和持续性方面发挥重要作用。
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