Lilly USA, LLC, Indianapolis, IN, USA.
Psychol Med. 2011 Jun;41(6):1291-300. doi: 10.1017/S0033291710001893. Epub 2010 Oct 7.
Schizophrenia is a heterogeneous disorder in terms of patient response to antipsychotic treatment. Understanding the heterogeneity of treatment response may help to guide treatment decisions. This study was undertaken to capture inherent patterns of response to antipsychotic treatment in patients with schizophrenia, characterize the subgroups of patients with similar courses of response, and examine illness characteristics at baseline as possible predictors of response.
Growth mixture modeling (GMM) was applied to data from a randomized, double-blind, 12-week study of 628 patients with schizophrenia or schizo-affective disorder treated with risperidone or olanzapine.
Four distinct response trajectories based on Positive and Negative Syndrome Scale (PANSS) total score over 12 weeks were identified: Class 1 (420 patients, 80.6%) with moderate average baseline PANSS total score showing gradual symptom improvement; Class 2 (65 patients, 12.5%) showing rapid symptom improvement; Class 3 (24 patients, 4.6%) with high average baseline PANSS total score showing gradual symptom improvement; and Class 4 (12 patients, 2.3%) showing unsustained symptom improvement. Latent class membership of early responders (ER) and early non-responders (ENR) was determined based on 20% symptom improvement criteria at 2 weeks and ultimate responders (UR) and ultimate non-responders (UNR) based on 40% symptom improvement criteria at 12 weeks. Baseline factors with potential influence on latent class membership were identified.
This study identified four distinct treatment response patterns with predominant representation of responders or non-responders to treatment in these classes. This heterogeneity may represent discrete endophenotypes of response to treatment with different etiologic underpinnings.
精神分裂症患者对抗精神病药物治疗的反应存在异质性。了解治疗反应的异质性可能有助于指导治疗决策。本研究旨在捕捉精神分裂症患者对抗精神病治疗反应的固有模式，描述具有相似反应过程的患者亚组，并检查基线时的疾病特征是否可能成为反应的预测指标。
采用增长混合模型（GMM）对 628 例精神分裂症或分裂情感障碍患者进行的一项随机、双盲、12 周研究的数据进行分析，这些患者接受利培酮或奥氮平治疗。
根据阳性和阴性综合征量表（PANSS）总分在 12 周内的变化，确定了 4 种不同的反应轨迹：第 1 类（420 例，80.6%）基线 PANSS 总分中等，表现为症状逐渐改善；第 2 类（65 例，12.5%）表现为快速症状改善；第 3 类（24 例，4.6%）基线 PANSS 总分较高，表现为症状逐渐改善；第 4 类（12 例，2.3%）表现为症状改善不持续。根据 2 周时 20%症状改善标准确定早期反应者（ER）和早期无反应者（ENR）的潜在类别成员，根据 12 周时 40%症状改善标准确定最终反应者（UR）和最终无反应者（UNR）。确定了对潜在类别成员有潜在影响的基线因素。
本研究确定了 4 种不同的治疗反应模式，这些模式以这些类别中治疗的反应者或无反应者为主。这种异质性可能代表了对治疗反应的离散内表型，具有不同的病因基础。
