Wallerstedt Susanna M, Lindh Jonatan D
*Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg; and †Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Ther Drug Monit. 2015 Aug;37(4):461-5. doi: 10.1097/FTD.0000000000000167.
Although therapeutic drug monitoring (TDM) is considered an underused tool in psychiatric care, the prevalence of TDM is largely unknown. The aim of this study was to analyze the prevalence of TDM for antidepressants and antipsychotics during 2006-2013.
The study population consisted of individuals ≥5 years of age residing in Stockholm County. The prevalence of TDM for each study year was calculated with the number of individuals in whom TDM had been performed as nominator (extracted from the TDM database at Karolinska University Laboratory) and the number of treated individuals as denominator (extracted from the Swedish Prescribed Drug Register). All data were obtained at the third and the fifth level of the anatomical therapeutic chemical classification system (pharmacological subgroup and chemical substance, respectively). The prevalence of TDM was compared between substances according to the level of TDM recommendation by guidelines.
For antidepressants, the prevalence of TDM decreased from 0.48% (95% confidence interval, 0.45%-0.52%) in 2006 to 0.36% (0.33%-0.39%) in 2013 (among 133,275 and 162,998 treated individuals, respectively). For antipsychotics, the prevalence of TDM increased from 2.3% (2.2%-2.5%) to 4.1% (3.9%-4.3%) (31,463 and 32,534 treated individuals). For both drug groups, TDM was more common in men than in women. The most frequently analyzed drugs were clozapine, perphenazine, zuclopenthixol, nortriptyline, and flupentixol. Although not reaching statistical significance, the TDM prevalence was greater for substances strongly recommended for TDM than for substances with a lower level of recommendation, median (interquartile range): 5.6% (2.8%-22%) versus 1.1% (0.2%-2.2%), P = 0.063.
The prevalence of TDM is generally low, more frequent, and increasing for antipsychotics, and more frequent for men and substances where TDM is strongly recommended.
尽管治疗药物监测（TDM）在精神科护理中被认为是一种未得到充分利用的工具，但TDM的普及率在很大程度上尚不清楚。本研究的目的是分析2006 - 2013年期间抗抑郁药和抗精神病药的TDM普及率。
研究人群包括居住在斯德哥尔摩县年龄≥5岁的个体。每个研究年份的TDM普及率通过将进行TDM的个体数量作为分子（从卡罗林斯卡大学实验室的TDM数据库中提取）和接受治疗的个体数量作为分母（从瑞典处方药登记处提取）来计算。所有数据均在解剖学治疗化学分类系统的第三级和第五级（分别为药理亚组和化学物质）获得。根据指南中TDM推荐水平比较不同药物的TDM普及率。
对于抗抑郁药，TDM普及率从2006年的0.48%（95%置信区间，0.45% - 0.52%）降至2013年的0.36%（0.33% - 0.39%）（分别为133,275名和162,998名接受治疗的个体）。对于抗精神病药，TDM普及率从2.3%（2.2% - 2.5%）增至4.1%（3.9% - 4.3%）（31,463名和32,534名接受治疗的个体）。对于这两类药物，男性的TDM比女性更常见。最常分析的药物是氯氮平、奋乃静、珠氯噻醇、去甲替林和氟哌噻吨。尽管未达到统计学显著性，但对于强烈推荐进行TDM的药物，其TDM普及率高于推荐水平较低的药物，中位数（四分位间距）：5.6%（2.8% - 22%）对1.1%（0.2% - 2.2%），P = 0.063。
TDM的普及率总体较低，抗精神病药的TDM更频繁且呈上升趋势，男性以及强烈推荐进行TDM的药物的TDM更常见。
