University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
Schizophr Res. 2013 Jul;147(2-3):375-82. doi: 10.1016/j.schres.2013.04.014. Epub 2013 May 1.
Differences among antipsychotics in terms of effectiveness have turned out to be a topic of increasing research interest, although comparisons between the different second generation antipsychotics (SGAs) are scarce. We aimed to compare the clinical effectiveness in the short-term of Aripiprazole, Ziprasidone and Quetiapine in the treatment of first-episode schizophrenia-spectrum disorders.
From October 2005 to January 2011, a prospective, randomized, open-label study was undertaken. 202 first-episode drug-naïve patients were randomly assigned to Aripiprazole (N = 78), Ziprasidone (N = 62), or Quetiapine (N = 62) and followed-up for 3 months. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on intention-to-treat populations was conducted in the analysis for clinical efficacy.
The overall dropout rate at 3 months was small (13.86%). The treatment discontinuation rate differed significantly between treatment groups (Aripiprazole = 23.1%, Ziprasidone = 37.1% and Quetiapine = 61.3%) (χ(2) = 21.334; p < 0.001). Insufficient efficacy in the group of Quetiapine is the main reason for discontinuation rate differences (χ(2) = 20.223; p < 0.001). The mean time to all-cause discontinuation was significantly different between groups (LogRank = 23.467 p < 0.001). Aripiprazole and Quetiapine were associated with a greater depressive symptoms improvement (p = 0.043). The profile of side-effects varies between treatments. Patients on Quetiapine were less likely to be prescribed hypnotics.
Patients treated with Quetiapine had a higher risk of treatment discontinuation in the short-term after a first episode due to insufficient efficacy. Establishing differences between SGAs may help clinicians in prescribing decisions for the treatment of individuals presenting with first-episode schizophrenia.
抗精神病药在疗效方面的差异已成为研究的热点，尽管不同第二代抗精神病药（SGAs）之间的比较很少。我们旨在比较阿立哌唑、齐拉西酮和喹硫平在治疗首发精神分裂症谱系障碍的短期临床疗效。
从 2005 年 10 月至 2011 年 1 月，进行了一项前瞻性、随机、开放标签研究。202 例首发、未经药物治疗的患者被随机分为阿立哌唑（N=78）、齐拉西酮（N=62）或喹硫平（N=62）组，并随访 3 个月。主要疗效指标为全因治疗中断。此外，还进行了基于意向治疗人群的临床疗效分析。
3 个月时总体辍学率较低（13.86%）。不同治疗组的治疗中断率差异有统计学意义（阿立哌唑=23.1%，齐拉西酮=37.1%，喹硫平=61.3%）（χ2=21.334；p<0.001）。喹硫平组疗效不足是导致停药率差异的主要原因（χ2=20.223；p<0.001）。全因停药的平均时间在组间差异有统计学意义（LogRank=23.467，p<0.001）。阿立哌唑和喹硫平与抑郁症状改善更大相关（p=0.043）。不良反应的特征在治疗之间有所不同。服用喹硫平的患者不太可能被开催眠药。
首发精神分裂症患者短期服用喹硫平治疗，由于疗效不足，停药风险更高。确定 SGA 之间的差异可能有助于临床医生为首发精神分裂症患者的治疗制定处方决策。
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