Lilly Research Centre, Eli Lilly and Company, Windlesham, Surrey, United Kingdom.
J Clin Psychopharmacol. 2010 Oct;30(5):531-40. doi: 10.1097/JCP.0b013e3181f14098.
The incidence of treatment-emergent extrapyramidal symptoms (EPSs) and tardive dyskinesia (TD) in schizophrenic patients, and the clinical characteristics associated with an increased risk of developing EPSs and TD were examined. Patients (N = 7728) in the 3-year, prospective, observational Schizophrenia Outpatient Health Outcomes study were examined according to baseline antipsychotic drug exposure. At baseline, 4893 patients (63.3%) had no EPS, and 6921 (89.6%) had no TD. Extrapyramidal symptoms and TD were assessed separately during follow-up: frequency and time to appearance from Kaplan-Meier survival curves and factors associated with time to appearance using Cox proportional hazard regression models. The cumulative incidence of EPS ranged from 7.7% (olanzapine) to 32.8% (depot typical drugs). Compared with olanzapine, patients taking depot typical drugs, oral typical drugs, risperidone, and amisulpride had a significantly higher risk of developing EPS. Differences from clozapine were marginally significant. High baseline clinical severity was associated with a significantly higher risk of developing EPS. The incidence of TD ranged from 2.8% (olanzapine) to 11.1% (depot typical agent). Compared with olanzapine, patients taking depot typical agents, oral typical agents, and risperidone had a significantly higher risk of developing TD. Baseline factors associated with a significantly higher risk of developing TD were age, EPS, a higher negative Clinical Global Impression score, and presence of gynecomastia. In summary, patients treated with typical antipsychotic agents (oral and depot) and risperidone had a higher risk of developing EPS and TD than patients treated with olanzapine. Higher baseline clinical severity was associated with EPS development, whereas age, presence of EPS, a higher negative Clinical Global Impression score, and presence of gynecomastia were associated with TD development.
研究了精神分裂症患者中治疗中出现的锥体外系症状（EPS）和迟发性运动障碍（TD）的发生率，以及与 EPS 和 TD 发生风险增加相关的临床特征。根据基线抗精神病药物暴露情况，对为期 3 年的前瞻性、观察性精神分裂症门诊患者健康结局研究中的 7728 例患者进行了检查。基线时，4893 例（63.3%）患者无 EPS，6921 例（89.6%）患者无 TD。在随访期间分别评估了 EPS 和 TD：从 Kaplan-Meier 生存曲线评估频率和出现时间，使用 Cox 比例风险回归模型评估与出现时间相关的因素。EPS 的累积发生率范围为 7.7%（奥氮平）至 32.8%（长效典型药物）。与奥氮平相比，服用长效典型药物、口服典型药物、利培酮和氨磺必利的患者发生 EPS 的风险显著更高。与氯氮平相比，差异具有边缘显著性。基线临床严重程度较高与发生 EPS 的风险显著增加相关。TD 的发生率范围为 2.8%（奥氮平）至 11.1%（长效典型药物）。与奥氮平相比，服用长效典型药物、口服典型药物和利培酮的患者发生 TD 的风险显著更高。与发生 TD 风险显著增加相关的基线因素包括年龄、EPS、更高的阴性临床总体印象评分和存在男性乳房发育。总之，与服用奥氮平的患者相比，服用典型抗精神病药物（口服和长效）和利培酮的患者发生 EPS 和 TD 的风险更高。较高的基线临床严重程度与 EPS 的发生相关，而年龄、存在 EPS、更高的阴性临床总体印象评分和存在男性乳房发育与 TD 的发生相关。
