氯氮平与精神分裂症患者的长期死亡风险：持续 1.1-12.5 年的研究的系统评价和荟萃分析。
Clozapine and Long-Term Mortality Risk in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Studies Lasting 1.1-12.5 Years.
机构信息
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef, AZ Amsterdam, The Netherlands.
Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY.
出版信息
Schizophr Bull. 2019 Mar 7;45(2):315-329. doi: 10.1093/schbul/sby052.
INTRODUCTION
Patients with schizophrenia have an elevated mortality risk compared to the general population, with cardiovascular-related deaths being the leading cause. The role of clozapine use in the long-term mortality risk is unclear. While clozapine treatment may increase the risk for cardiovascular mortality, it may have protective effects regarding suicidal behavior.
METHODS
We systematically searched EMBASE, MEDLINE, and PsycINFO and reviewed studies that used a long-term follow-up (ie, >52 weeks) and reported on mortality in adults diagnosed with schizophrenia-spectrum disorders who had received clozapine treatment.
RESULTS
Altogether, 24 studies reported on 1327 deaths from any causes during 217691 patient years in patients treated with clozapine. The unadjusted mortality rate in 22 unique samples during a follow-up of 1.1-12.5 (median = 5.4) years was 6.7 (95% confidence interval [CI] = 5.4-7.9) per 1000 patient years. Long-term, crude mortality rate ratios were not significantly lower in patients ever treated with clozapine during follow-up, but significantly lower in patients continuously treated with clozapine compared to patients with other antipsychotics (mortality rate ratio = 0.56, 95% CI = 0.36-0.85, P-value = .007). Few studies reported on rates of long-term cause-specific mortality (suicide and ischemic heart disease), which showed no significant difference in patients using clozapine compared to patients using other antipsychotics. Statistical heterogeneity was high in all analyses.
DISCUSSION
Continuous clozapine treatment in schizophrenia patients was associated with a significantly lower long-term all-cause mortality rate compared to other antipsychotic use. These findings, combined with the known efficacy of clozapine, give reason to re-evaluate the hesitancy to prescribe clozapine in regular care settings.
TRIAL REGISTRATION
PROSPERO CRD42017069390.
简介
与普通人群相比，精神分裂症患者的死亡率较高，心血管相关死亡是主要原因。氯氮平使用与长期死亡率之间的关系尚不清楚。虽然氯氮平治疗可能会增加心血管死亡率的风险，但它可能对自杀行为有保护作用。
方法
我们系统地检索了 EMBASE、MEDLINE 和 PsycINFO，并回顾了使用长期随访（即>52 周）并报告精神分裂症谱系障碍患者接受氯氮平治疗后的死亡率的研究。
结果
共有 24 项研究报告了在接受氯氮平治疗的患者中，在 217691 患者年中有 1327 例任何原因导致的死亡。在 1.1-12.5 年（中位数=5.4）的随访中，22 个独特样本的未调整死亡率为 6.7（95%置信区间[CI] = 5.4-7.9）/1000 患者年。在长期随访期间，曾接受氯氮平治疗的患者的粗死亡率比率没有显著降低，但与接受其他抗精神病药物治疗的患者相比，连续接受氯氮平治疗的患者的死亡率比率显著降低（死亡率比率=0.56，95%CI=0.36-0.85，P 值=0.007）。很少有研究报告长期特定原因死亡率（自杀和缺血性心脏病）的发生率，与使用氯氮平的患者相比，使用其他抗精神病药物的患者没有显著差异。所有分析的统计异质性均很高。
讨论
与其他抗精神病药物相比，精神分裂症患者持续接受氯氮平治疗与长期全因死亡率显著降低相关。这些发现，加上氯氮平的已知疗效，使得重新评估在常规护理环境中开具氯氮平的犹豫态度成为可能。
试验注册
PROSPERO CRD42017069390。
Zotero 插件