Wheeler Amanda, Vanderpyl Jane, Carswell Chris, Stojkovic Mirjana, Robinson Elizabeth
Clinical Research & Resource Centre, Mental Health and Addiction Services, Waitemata District Health Board, New Zealand.
Clin Schizophr Relat Psychoses. 2012 Jul;6(2):61-8. doi: 10.3371/CSRP.6.2.3.
Treatment discontinuation is a major problem in routine clinical settings and is associated with poorer outcomes for conditions like schizophrenia. Risperidone long-acting injection (RLAI) has shown low discontinuation and good tolerability in long-term clinical trials. This retrospective study investigated RLAI continuation in a naturalistic clinical setting in New Zealand.
Those starting publicly funded RLAI between October 1, 2005 and October 31, 2006 in five public mental health services were included in the study. Data were retrospectively collected for 443 patients 12 months pre- and post-RLAI initiation. Patient demographics, diagnosis, antipsychotic treatment and treatment setting were obtained from clinical files and patient information systems.
Patients were mostly male (64%), the mean age was 35.9 years, and were predominantly European (43%) or Māori (29%). Most started RLAI due to adherence issues (77%). Adverse events due to RLAI were reported by 39%; most commonly, extrapyramidal side effects. Fifty-eight percent of patients continued treatment 12 months after starting; patient choice (either refusal or failure to turn up) was the most common reason for discontinuation (54%), followed by lack of efficacy (29%). Alternative antipsychotic treatment was prescribed for 79% of those who discontinued. Regression analysis found continuation was more common for people started in the community, on a compulsory treatment order, with a dose of >25 mg and for non-Māori.
RLAI appears well-tolerated and over half the patients continued treatment for one year or more. Using treatment continuation as an indicator of effectiveness, RLAI appears to be an effective treatment for people with adherence problems in this real world practice setting.
在常规临床环境中，治疗中断是一个主要问题，并且与精神分裂症等疾病的较差预后相关。在长期临床试验中，利培酮长效注射剂（RLAI）已显示出低中断率和良好的耐受性。这项回顾性研究调查了新西兰自然临床环境中RLAI的持续使用情况。
纳入2005年10月1日至2006年10月31日期间在五个公共心理健康服务机构开始接受公费RLAI治疗的患者。回顾性收集了443例患者在开始使用RLAI前12个月和后12个月的数据。患者的人口统计学信息、诊断、抗精神病药物治疗和治疗环境均从临床档案和患者信息系统中获取。
患者大多为男性（64%），平均年龄为35.9岁，主要为欧洲裔（43%）或毛利人（29%）。大多数患者开始使用RLAI是由于依从性问题（77%）。39%的患者报告了RLAI引起的不良事件；最常见的是锥体外系副作用。58%的患者在开始治疗12个月后继续治疗；患者的选择（拒绝或未出现）是中断治疗的最常见原因（54%），其次是疗效不佳（29%）。79%中断治疗的患者接受了替代抗精神病药物治疗。回归分析发现，在社区开始治疗、接受强制治疗令、剂量>25 mg的患者以及非毛利人继续治疗的情况更为常见。
RLAI似乎耐受性良好，超过一半的患者持续治疗了一年或更长时间。将治疗持续作为有效性指标，在这种现实世界的实践环境中，RLAI似乎是治疗依从性问题患者的有效治疗方法。
