Cordiner Matthew, Shajahan Polash, McAvoy Sarah, Bashir Muhammad, Taylor Mark
NHS Lanarkshire, Bellshill, UK.
NHS Lanarkshire, Bellshill Clinic, Greenmoss Place, Bellshill ML4 1PS, UK.
Ther Adv Psychopharmacol. 2016 Feb;6(1):22-32. doi: 10.1177/2045125315623168.
In the UK, nine different compounds are available as long-acting antipsychotic injections (LAIs). There are few clinical guidelines for determining which LAIs are most effective in specific patient groups. To measure the clinical effectiveness of LAIs we aimed to determine the now-established concept of antipsychotic discontinuation rates and measure Clinical Global Impression (CGI) outcomes.
The population (n was approximately 560,000) was a secondary care NHS adult mental health service in Lanarkshire, Scotland, UK. This was a retrospective, electronic case note search of LAI-naïve patients commenced on paliperidone palmitate (n = 31), risperidone long-acting injection (RLAI) (n = 102) or zuclopenthixol decanoate (n = 105), with an 18-month follow up. Kaplan-Meier survival statistics for discontinuation rates and hospital admission were calculated. CGI severity and improvement scores were retrospectively assigned by the investigating team.
Paliperidone palmitate performed less favourably than risperidone long-acting injection (RLAI) or zuclopenthixol decanoate. Paliperidone palmitate had higher discontinuation rates due to any cause, inefficacy and increased hospitalization risk. Paliperidone palmitate had the smallest proportion of patients assigned a clinically desirable CGI-I score of 1 (very much improved) or 2 (much improved).
Paliperidone palmitate had less favourable discontinuation and CGI outcomes compared with RLAI and zuclopenthixol decanoate. This could not be adequately explained by patients in the paliperidone group being more chronically or severely unwell, nor by the presence of comorbidities such as alcohol or substance misuse, or by the use of lower mean dosages compared with RLAI or zuclopenthixol decanoate. We considered that prescribers are familiarizing themselves with paliperidone and outcomes may improve over time.
在英国，有九种不同的化合物可作为长效抗精神病药物注射剂（LAIs）使用。关于确定哪些LAIs在特定患者群体中最有效的临床指南很少。为了衡量LAIs的临床疗效，我们旨在确定现已确立的抗精神病药物停药率概念，并衡量临床总体印象（CGI）结果。
研究人群（n约为560,000）是英国苏格兰拉纳克郡的国民保健服务（NHS）二级护理成人心理健康服务机构。这是一项对初用LAIs的患者进行的回顾性电子病历搜索，这些患者开始使用棕榈酸帕利哌酮（n = 31）、长效利培酮注射剂（RLAI）（n = 102）或癸酸珠氯噻醇（n = 105），并进行了18个月的随访。计算了停药率和住院率的Kaplan-Meier生存统计数据。研究团队回顾性地分配了CGI严重程度和改善分数。
棕榈酸帕利哌酮的表现不如长效利培酮注射剂（RLAI）或癸酸珠氯噻醇。由于任何原因、无效和住院风险增加，棕榈酸帕利哌酮的停药率更高。棕榈酸帕利哌酮组中，被评定为临床理想的CGI-I评分为1（非常有改善）或2（有很大改善）的患者比例最小。
与RLAI和癸酸珠氯噻醇相比，棕榈酸帕利哌酮的停药情况和CGI结果较差。这不能通过棕榈酸帕利哌酮组患者病情更慢性或更严重、存在酒精或药物滥用等合并症，或与RLAI或癸酸珠氯噻醇相比使用较低平均剂量来充分解释。我们认为，开处方者正在熟悉帕利哌酮，随着时间的推移结果可能会改善。
