Miyamoto Seiya, Wolfgang Fleischhacker W
Department of Psychiatry, Sakuragaoka Memorial Hospital, 1-1-1 Renkoji, Tama-shi, Tokyo 206-0021 Japan.
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Curr Treat Options Psychiatry. 2017;4(2):117-126. doi: 10.1007/s40501-017-0115-z. Epub 2017 Apr 19.
Schizophrenia is a mostly chronic mental disorder, and symptomatic relapse is frequently observed. It is often associated with social and/or occupational decline that can be difficult to reverse. Most patients with the illness need long-term pharmacological treatment, and antipsychotic drugs represent the mainstay of clinical care. Long-acting injectable antipsychotics (LAIs) are an important alternative to oral medication, particularly advantageous in the context of compliance management. Several new-generation antipsychotics (NGAs), including risperidone, olanzapine, paliperidone, and aripiprazole, have become available as long-acting formulations, and new evidence has been accumulating. To date, all of the NGA LAIs have demonstrated a statistically and clinically significant decrease of relapse rates over placebo. The results of clinical trials comparing NGA LAIs with oral antipsychotics (OAPs) are not consistent, as being influenced considerably by study design. Superiority of LAIs to OAPs in efficacy is most evident in mirror image and cohort studies. New-generation LAIs are comparable to their oral mother compounds regarding safety and tolerability if one disregards potential injection site complications. There is little evidence of efficacy differences between the available LAIs, but they have different characteristics in terms of pharmacodynamic and pharmacokinetic profiles, injection interval, cost, requirements for oral supplementation, as well as adverse events. Considering these differences is useful for selecting LAIs for the treatment of individual patients. There is increasing evidence suggesting the use of LAIs in special patient groups, such as first-episode or forensic schizophrenia patients. This article reviews data on the use of NGA LAIs in schizophrenia and discusses current issues from clinical and methodological perspectives.
精神分裂症是一种大多为慢性的精神障碍，症状复发很常见。它常与难以逆转的社会和/或职业衰退相关。大多数该疾病患者需要长期药物治疗，抗精神病药物是临床治疗的主要手段。长效注射用抗精神病药物（LAIs）是口服药物的重要替代选择，在依从性管理方面尤其具有优势。几种新一代抗精神病药物（NGAs），包括利培酮、奥氮平、帕利哌酮和阿立哌唑，都有长效剂型可供使用，且新证据不断积累。迄今为止，所有的新一代长效抗精神病药物与安慰剂相比，复发率均有统计学和临床意义上的显著降低。比较新一代长效抗精神病药物与口服抗精神病药物（OAPs）的临床试验结果并不一致，这在很大程度上受研究设计的影响。长效注射用抗精神病药物在疗效上优于口服抗精神病药物在镜像研究和队列研究中最为明显。如果不考虑潜在的注射部位并发症，新一代长效抗精神病药物在安全性和耐受性方面与其口服母药相当。现有长效注射用抗精神病药物之间几乎没有疗效差异的证据，但它们在药效学和药代动力学特征、注射间隔、成本、口服补充需求以及不良事件方面具有不同特点。考虑这些差异有助于为个体患者选择长效注射用抗精神病药物。越来越多的证据表明长效注射用抗精神病药物可用于特殊患者群体，如首发或法医鉴定的精神分裂症患者。本文综述了新一代长效抗精神病药物在精神分裂症治疗中的应用数据，并从临床和方法学角度讨论了当前问题。
