Tompsett Tamara, Masters Kate, Donyai Parastou
Department of Pharmacy, University of Reading, Reading, UK.
Department of Pharmacy, Berkshire Healthcare NHS Foundation Trust, Reading, UK.
Neuropsychiatr Dis Treat. 2018 Mar 2;14:681-691. doi: 10.2147/NDT.S151174. eCollection 2018.
A number of naturalistic studies have investigated paliperidone palmitate (PP) using proxy measures of effectiveness. An unexplored option is to examine the utility of the mental health clustering tool (MHCT), which is used in UK clinical practice to measure patient well-being and is linked to allocation of resources. This study evaluated the effectiveness of PP using the MHCT, the Health of the Nation Outcome Scales (HoNOS), and, for comparison, more conventional outcome measures.
This was a naturalistic, 1-year evaluation of PP (n=50) in schizophrenia as well as a comparator antipsychotic drugs group. Changes in the MHCT cluster-score cost ranking and four HoNOS-derived factors were analyzed using a mixed-model statistical analysis to explore the utility of these measures.
At 1 year, 30 patients (60%) continued PP treatment. The mean "cluster-score cost ranking" (-1.5) and Severe Disturbance factor scores (-1.1) were significantly lower (-value [adjusted] =0.0003, -value [adjusted] =0.002, respectively) after 1 year of antipsychotic treatment but no differences were found between PP and the comparator antipsychotic drugs group. Patients prescribed PP were 1.8 times (95% CI 1.1-3.1) more likely to be discharged from hospital than those in the comparator antipsychotic drugs group.
PP's continuation rate after 1 year made the study similar to the existing evaluations, and it was possible to prospectively evaluate antipsychotic effectiveness using the novel measures although these did not discriminate between PP and the comparator group. The investigation illustrates that in principle these novel measures are meaningful in naturalistic study designs.
多项自然主义研究使用有效性的替代指标对棕榈酸帕利哌酮（PP）进行了调查。一个未被探索的选择是研究心理健康聚类工具（MHCT）的效用，该工具在英国临床实践中用于衡量患者的幸福感，并与资源分配相关。本研究使用MHCT、国家健康结果量表（HoNOS）以及作为比较的更传统的结果指标来评估PP的有效性。
这是一项对精神分裂症患者中PP（n = 50）以及一个对照抗精神病药物组进行的为期1年的自然主义评估。使用混合模型统计分析来分析MHCT聚类得分成本排名和四个源自HoNOS的因素的变化，以探索这些指标的效用。
1年后，30名患者（60%）继续接受PP治疗。抗精神病治疗1年后，平均“聚类得分成本排名”（-1.5）和严重干扰因子得分（-1.1）显著降低（调整后p值分别为0.0003和0.002），但PP组与对照抗精神病药物组之间未发现差异。接受PP治疗的患者出院的可能性是对照抗精神病药物组患者的1.8倍（95%置信区间1.1 - 3.1）。
1年后PP的持续治疗率使该研究与现有评估相似，并且尽管这些新指标无法区分PP组和对照组，但使用这些新指标前瞻性评估抗精神病药物的有效性是可行的。该调查表明，原则上这些新指标在自然主义研究设计中是有意义的。
