School of Pharmacy and Pharmaceutical Sciences, Cardiff University. Whitchurch Hospital, Park Road, Cardiff CF14 7XB, UK.
School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.
Ther Adv Psychopharmacol. 2015 Jun;5(3):151-7. doi: 10.1177/2045125315581997.
This study examined 5-year outcomes of patients prescribed risperidone long-acting injection (RLAI) or aripiprazole in a clinical setting, using treatment discontinuation as a measure of effectiveness.
Patients who received RLAI or aripiprazole in the 18 months following their respective UK launches were included. Two-year outcome data were previously reported for these cohorts; this study reported an additional 3 years of follow up for each group. Data were collected from pharmacy records and by retrospective case note review. Patients were classified as continuers or discontinuers at 5 years and reasons for treatment discontinuation noted.
The number of patients remaining on treatment at 2 years (and included in this study) was 28/84 and 27/92 for RLAI and aripiprazole respectively. Two patients treated with RLAI and three treated with aripiprazole were lost to follow up. Therefore, 5-year outcome data were available for 50 patients. Fifteen patients from each group were continuers at 5 years. Of these, four receiving RLAI and three receiving aripiprazole were coprescribed other antipsychotics at study endpoint. Reasons for discontinuation of RLAI and aripiprazole respectively were lack of effect (n = 4; n = 4), adverse effects (n = 3; n = 1), noncompliance or patient choice (n = 2; n = 4) and patient death (n = 2; n = 0).
There was no significant difference between the proportions of patients continuing RLAI or aripiprazole for 5 years. Continuation rates were relatively low (18% and 16% of the original RLAI and aripiprazole cohorts respectively), whilst coprescription of other antipsychotics at endpoint was relatively common. Lack of effectiveness was the most common reason for discontinuation of both compounds. These findings suggested that clinical effectiveness was somewhat disappointing, although the long period of follow up and number of patients previously treated with clozapine in the original cohorts were confounding factors.
本研究考察了在临床环境中使用利培酮长效注射剂（RLAI）或阿立哌唑治疗的患者的 5 年结局，以停药作为有效性的衡量标准。
纳入了在各自英国上市后 18 个月内接受 RLAI 或阿立哌唑治疗的患者。这两个队列的两年结局数据此前已报道；本研究报告了每个队列额外 3 年的随访结果。数据来自于药房记录和回顾性病历审查。将患者在 5 年内分为继续治疗者和停药者，并记录停药原因。
在第 2 年（并纳入本研究）继续治疗的患者人数分别为 RLAI 组 28/84 和阿立哌唑组 27/92。两名接受 RLAI 治疗的患者和三名接受阿立哌唑治疗的患者失访。因此，50 名患者可提供 5 年结局数据。每组各有 15 名患者在 5 年内继续治疗。其中，4 名接受 RLAI 治疗和 3 名接受阿立哌唑治疗的患者在研究终点时同时服用了其他抗精神病药物。RLAI 和阿立哌唑停药的原因分别为缺乏疗效（n=4；n=4）、不良反应（n=3；n=1）、不依从或患者选择（n=2；n=4）和患者死亡（n=2；n=0）。
继续接受 RLAI 或阿立哌唑治疗 5 年的患者比例无显著差异。继续治疗率相对较低（分别为最初的 RLAI 和阿立哌唑队列的 18%和 16%），而在研究终点同时使用其他抗精神病药物的情况相对常见。两种药物停药的最常见原因均为缺乏疗效。这些结果表明，临床疗效有些令人失望，尽管原始队列中之前接受氯氮平治疗的患者数量和随访时间较长是混杂因素。
