Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Psychopharmacology (Berl). 2011 Aug;216(4):475-84. doi: 10.1007/s00213-011-2242-3. Epub 2011 Mar 3.
The relative effectiveness of the atypical antipsychotic drugs and conventional agents in patients with early-stage schizophrenia has not been comprehensively determined.
The aim of our study was to evaluate the efficacy and safety of seven antipsychotic drugs for the maintenance treatment in patients with early-stage schizophrenia.
In a 12-month open-label, prospective observational, multicenter study, 1,133 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine, or aripiprazole. The primary measure was the rate of treatment discontinuation for any reason. Secondary outcomes included measures for clinical and functional outcomes and tolerability.
The percentage of patients discontinued treatment within 12 months was 41.4% for chlorpromazine, 39.5% for sulpiride, 36.7% for clozapine, 40.2% for risperidone, 39.6% for olanzapine, 46.9% for quetiapine, and 40.2% for aripiprazole, a nonsignificant difference (p = 0.717); there were no significant differences among these seven treatments on discontinuation due to relapse, intolerability, patient decision, or nonadherence (all p values ≥ 0.260). Extrapyramidal symptoms were more prominent in chlorpromazine and sulpiride treatment groups. Anticholinergic side effects were most common with clozapine and chlorpromazine. Weight gain was most common with olanzapine and clozapine.
The efficacy of seven antipsychotic medications for the maintenance treatment appeared similar in early-stage schizophrenia. With regard to the high dropout rate and side effects, special programs are needed to keep efficacy and safety of antipsychotics maintenance treatment for schizophrenia with early stage.
抗精神病药的疗效在早期精神分裂症患者中的相对有效性尚未得到全面确定。
本研究旨在评估 7 种抗精神病药物在早期精神分裂症患者中的维持治疗效果和安全性。
在一项为期 12 个月的、开放标签、前瞻性、多中心研究中，1133 例发病 5 年内的精神分裂症或精神分裂样障碍患者接受了氯丙嗪、舒必利、氯氮平、利培酮、奥氮平、喹硫平或阿立哌唑的单药治疗。主要疗效指标为任何原因停药的比例。次要结局指标包括临床和功能结局及耐受性的测量指标。
在 12 个月内停药的患者比例为：氯丙嗪组 41.4%，舒必利组 39.5%，氯氮平组 36.7%，利培酮组 40.2%，奥氮平组 39.6%，喹硫平组 46.9%，阿立哌唑组 40.2%，差异无统计学意义（p=0.717）；在因复发、不耐受、患者决定或不依从而停药的比例方面，这 7 种治疗方案之间也无显著差异（p 值均≥0.260）。氯丙嗪和舒必利组锥体外系症状更明显。氯氮平和氯丙嗪组的抗胆碱能副作用最常见。体重增加最常见于奥氮平和氯氮平组。
7 种抗精神病药物在早期精神分裂症患者中的维持治疗效果似乎相似。鉴于高脱落率和副作用，需要制定特殊方案，以保证早期精神分裂症患者抗精神病药物维持治疗的疗效和安全性。
