Hayes Joseph F, Marston Louise, Walters Kate, Geddes John R, King Michael, Osborn David P J
Division of Psychiatry, University College London, London, W1T 7NF, UK.
Department of Primary Care and Population Health, University College London, London, UK.
World Psychiatry. 2016 Feb;15(1):53-8. doi: 10.1002/wps.20298.
It is unclear which maintenance treatment for bipolar disorder is superior in clinical practice. Randomized controlled head-to-head trials of available drugs either do not exist or are inconclusive. We aimed to compare rates of monotherapy treatment failure in individuals prescribed lithium, valproate, olanzapine or quetiapine by a population-based cohort study using electronic health records. 5,089 patients with bipolar disorder were prescribed lithium (N=1,505), valproate (N=1,173) olanzapine (N=1,366) or quetiapine (N=1,075) as monotherapy. Treatment failure was defined as time to stopping medication or add-on of another mood stabilizer, antipsychotic, antidepressant or benzodiazepine. In unadjusted analyses, the duration of successful monotherapy was longest in individuals treated with lithium. Treatment failure had occurred in 75% of those prescribed lithium by 2.05 years (95% CI: 1.63-2.51), compared to 0.76 years (95% CI: 0.64-0.84) for those prescribed quetiapine, 0.98 years (95% CI: 0.84-1.18) for those prescribed valproate, and 1.13 years for those prescribed olanzapine (95% CI: 1.00-1.31). Lithium's superiority remained in a propensity score matched analysis; when treatment failure was defined as stopping medication or add-on of a mood stabilizer or antipsychotic; and when treatment failure was restricted to more than three months after commencing the study drug. Lithium appears to be more successful as monotherapy maintenance treatment than valproate, olanzapine or quetiapine. Lithium is often avoided because of its side effect profile, but alternative treatments may reduce the time to being prescribed more than one drug, with potential additive side effects of these treatments.
在临床实践中，尚不清楚哪种双相情感障碍维持治疗方法更具优势。现有的药物之间缺乏随机对照的直接比较试验，或者这些试验尚无定论。我们旨在通过一项基于人群的队列研究，利用电子健康记录，比较接受锂盐、丙戊酸盐、奥氮平或喹硫平单药治疗的个体中，单药治疗失败的发生率。5089例双相情感障碍患者接受了锂盐（N = 1505）、丙戊酸盐（N = 1173）、奥氮平（N = 1366）或喹硫平（N = 1075）单药治疗。治疗失败定义为停药时间或加用另一种心境稳定剂、抗精神病药、抗抑郁药或苯二氮䓬类药物的时间。在未调整分析中，接受锂盐治疗的个体单药成功治疗的持续时间最长。到2.05年时，接受锂盐治疗的患者中有75%出现治疗失败（95%CI：1.63 - 2.51），而接受喹硫平治疗的患者为0.76年（95%CI：0.64 - 0.84），接受丙戊酸盐治疗的患者为0.98年（95%CI：0.84 - 1.18），接受奥氮平治疗的患者为1.13年（95%CI：1.00 - 1.31）。在倾向评分匹配分析中，锂盐的优势依然存在；当治疗失败定义为停药或加用心境稳定剂或抗精神病药时；以及当治疗失败仅限于开始研究药物三个月后时。作为单药维持治疗，锂盐似乎比丙戊酸盐、奥氮平或喹硫平更成功。由于锂盐的副作用，它常常不被选用，但替代治疗可能会缩短使用多种药物的时间，而这些治疗可能会产生叠加的副作用。
