Fisher Maxine D, Reilly Kathleen, Isenberg Keith, Villa Kathleen F
BMC Psychiatry. 2014 Nov 30;14:341. doi: 10.1186/s12888-014-0341-5.
The objective of this study was to characterize real-world treatment patterns in the prescription of antipsychotic polypharmacy (≥ 2 concurrent antipsychotics) compared with antipsychotic monotherapy for patients with schizophrenia.
This study was a retrospective claims-based analysis of patients (aged 13-64 years) with schizophrenia belonging to an employer-based health plan. Duration of therapy was measured as the number of treatment days over one year following the initial date of antipsychotic therapy. Discontinuation was defined as a 90-day gap in antipsychotic treatment (or in at least one antipsychotic for the polypharmacy group). Logistic regression analyses were used to predict discontinuation within one year. Ordinary Least Squares (OLS) regressions were used to predict duration of therapy (by type of therapy) when controlling for gender, region, number of somatic and psychiatric comorbidities, Deyo-Charlson comorbidity score, and number of psychiatric and somatic medications.
Of the 4,156 patients, 3,188 received monotherapy and 968 received polypharmacy. Mean age was 40 years (37.8 years for polypharmacy vs 40.3 years for monotherapy, p < 0.001). Within one year, 77% of the polypharmacy group and 54% of the monotherapy group discontinued treatment. The average duration of therapy was 163 [SD = 143] days in the polypharmacy group vs 253 [SD = 147] days in the monotherapy group. In both cohorts, patients <25 years had a higher frequency of discontinuations than those ≥ 26 years. Age and polypharmacy were independent predictors of treatment duration and discontinuation prior to one year.
One quarter of patients with schizophrenia received antipsychotic polypharmacy. Discontinuation was higher in the polypharmacy group. Age and polypharmacy were significant predictors of treatment discontinuation.
本研究的目的是描述精神分裂症患者使用抗精神病药物联合治疗（≥2种同时使用的抗精神病药物）与单一治疗相比的真实治疗模式。
本研究是一项基于索赔记录的回顾性分析，研究对象为参加雇主提供的健康保险计划的13至64岁精神分裂症患者。治疗持续时间以抗精神病治疗起始日期后一年内的治疗天数来衡量。停药定义为抗精神病治疗中断90天（多药联合治疗组中至少一种抗精神病药物中断90天）。采用逻辑回归分析预测一年内停药情况。在控制性别、地区、躯体和精神共病数量、Deyo-Charlson共病评分以及精神和躯体药物数量后，使用普通最小二乘法（OLS）回归预测治疗持续时间（按治疗类型）。
4156例患者中，3188例接受单一治疗，968例接受联合治疗。平均年龄为40岁（联合治疗组为37.8岁，单一治疗组为40.3岁，p<0.001）。一年内，联合治疗组77%的患者停药，单一治疗组54%的患者停药。联合治疗组的平均治疗持续时间为163[标准差=143]天，单一治疗组为253[标准差=147]天。在两个队列中，年龄<25岁的患者停药频率高于年龄≥26岁的患者。年龄和联合治疗是治疗持续时间和一年前停药的独立预测因素。
四分之一的精神分裂症患者接受了抗精神病药物联合治疗。联合治疗组的停药率更高。年龄和联合治疗是治疗停药的重要预测因素。
