Department of Psychiatry, Columbia University, College of Physicians & Surgeons and New York State Psychiatric Institute, New York, USA.
Br J Psychiatry. 2011 Oct;199(4):281-8. doi: 10.1192/bjp.bp.110.081471.
The differential effects of so-called 'first- and second generation' antipsychotic medications, when given in the first episode, on the long-term outcome of schizophrenia remain to be elucidated.
We compared the 9-year outcomes of individuals initially randomised to clozapine or chlorpromazine.
One-hundred and sixty individuals with treatment-naive, first episode schizophrenia or schizophreniform disorder in a mental health centre in Beijing, China were randomised to clozapine or chlorpromazine treatment for up to 2 years,followed by up to an additional 7 years of naturalistic treatment. The primary outcome was remission status for individuals in each group.
Individuals in both groups spent essentially equal amounts of time in each clinical state over the follow-up time period(remission, 78%; intermediate, 8%; relapse, 14%). There were no significant differences on other measures of illness severity. The clozapine group was more likely than the chlorpromazine group to remain on the medication to which they were originally assigned (26% v. 10%, P = 0.01). There were no significant differences between the two groups on other secondary efficacy outcomes.
These findings support the comparability in effectiveness between antipsychotic medications but with slightly greater tolerability of clozapine in the treatment of first-episode psychosis.
在首发精神分裂症患者中，第一代和第二代抗精神病药物的疗效差异，以及对精神分裂症的长期预后的影响，仍需阐明。
我们比较了氯氮平与氯丙嗪初始随机分组的个体 9 年的结局。
160 名来自中国北京某精神卫生中心的、未经治疗的首发精神分裂症或分裂样障碍患者，被随机分配接受氯氮平或氯丙嗪治疗，最长 2 年，随后进行长达 7 年的自然治疗随访。主要结局是两组患者的缓解情况。
在整个随访期间，两组患者在每种临床状态下的时间基本相同（缓解期 78%，中间状态 8%，复发期 14%）。两组患者在其他严重程度评估指标上无显著差异。氯氮平组比氯丙嗪组更有可能继续使用最初分配的药物（氯氮平组 26%，氯丙嗪组 10%，P = 0.01）。两组患者在其他次要疗效结局上无显著差异。
这些发现支持第一代和第二代抗精神病药物在疗效上的可比性，但氯氮平在治疗首发精神分裂症方面具有稍高的耐受性。
