Tonin Fernanda S, Wiens Astrid, Fernandez-Llimos Fernando, Pontarolo Roberto
Pharmaceutical Sciences Postgraduate Program.
Department of Pharmacy, Federal University of Parana, Curitiba, Brazil.
Core Evid. 2016 Dec 14;11:49-61. doi: 10.2147/CE.S114094. eCollection 2016.
Schizophrenia is a chronic and debilitating mental disorder that affects the patient's and their family's quality of life, as well as financial costs and health care settings. Despite the variety of available antipsychotics, optimal treatment outcomes are not always achieved. Novel drugs, such as iloperidone, can provide more effective, tolerable and safer strategies.
To review the evidence for the clinical impact of iloperidone on the treatment of patients with schizophrenia.
Clinical trials, observational studies and meta-analyses reached a common consensus that iloperidone is as effective as haloperidol, risperidone and ziprasidone in reducing schizophrenia symptoms. Similar amounts of adverse events and discontinuations were observed with iloperidone compared to placebo and active treatments. Common adverse events are mild and include dizziness, hypotension, dry mouth and weight gain. Iloperidone can induce extension of QTc interval, and clinicians should be aware of its contraindications. In long-term trials, iloperidone also showed promising safety and tolerability profiles. The low propensity to cause akathisia, extrapyramidal symptoms (EPS), increased prolactin levels or changes to metabolic laboratory parameters support its use in practice. Results showed that iloperidone prevents relapse in stabilized patients, with a time to relapse superior to placebo and similar to haloperidol. Patients using a prior antipsychotic (eg, risperidone and aripiprazole) can easily switch to iloperidone with no serious impact on safety or efficacy. However, the acquisition costs of iloperidone may hamper its use. Further evidence comparing iloperidone with other antipsychotics, and pharmacoeconomic studies would be welcome.
Considering just the clinical profile of iloperidone, it represents a promising drug for treating schizophrenia, particularly in patients who are intolerant to previous antipsychotics, as well as being suitable as first-line therapy. Cost-effectiveness comparisons are needed to justify its use in clinical practice.
精神分裂症是一种慢性且使人衰弱的精神障碍，会影响患者及其家庭的生活质量，还会产生经济成本并影响医疗保健环境。尽管有多种可用的抗精神病药物，但并非总能实现最佳治疗效果。新型药物，如伊潘立酮，可提供更有效、更耐受且更安全的治疗策略。
综述伊潘立酮对精神分裂症患者治疗临床影响的证据。
临床试验、观察性研究和荟萃分析达成了一个共识，即伊潘立酮在减轻精神分裂症症状方面与氟哌啶醇、利培酮和齐拉西酮一样有效。与安慰剂和活性治疗相比，伊潘立酮观察到的不良事件和停药数量相似。常见不良事件较轻，包括头晕、低血压、口干和体重增加。伊潘立酮可诱发QTc间期延长，临床医生应了解其禁忌证。在长期试验中，伊潘立酮还显示出良好的安全性和耐受性。导致静坐不能、锥体外系症状（EPS）、催乳素水平升高或代谢实验室参数改变的倾向较低，这支持了其在实际应用中的使用。结果表明，伊潘立酮可预防病情稳定患者的复发，复发时间优于安慰剂且与氟哌啶醇相似。之前使用过抗精神病药物（如利培酮和阿立哌唑）的患者可以轻松换用伊潘立酮，而对安全性或疗效无严重影响。然而，伊潘立酮的购置成本可能会妨碍其使用。欢迎提供更多将伊潘立酮与其他抗精神病药物进行比较的证据以及药物经济学研究。
仅考虑伊潘立酮的临床特征，它是一种治疗精神分裂症的有前景的药物，特别是对于那些对先前抗精神病药物不耐受的患者，也适合作为一线治疗药物。需要进行成本效益比较以证明其在临床实践中的使用合理性。
