Titus-Lay Erika N, Ansara Elayne D, Isaacs Alex N, Ott Carol A
Assistant Professor, Department of Clinical and Administrative Sciences, California Northstate University College of Pharmacy, Elk Grove, California,
Clinical Pharmacy Specialist, Psychiatry, Department of Pharmacy, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.
Ment Health Clin. 2018 Mar 26;8(2):56-62. doi: 10.9740/mhc.2018.03.056. eCollection 2018 Mar.
Despite the theory that long-acting injectable (LAI) antipsychotics should be more likely to improve adherence, reduce gaps in therapy, and prevent relapse compared with oral antipsychotics, there is little published evidence on this issue, specifically in patients with early psychosis.
Patients with a new diagnosis for a psychotic disorder between July 1, 2013, and August 31, 2014, were retrospectively evaluated during a 12-month duration. The primary outcomes were adherence and persistence. Adherence was determined by proportion of days with medication, and persistence was defined as zero gaps in medication therapy. The secondary outcome was the number of times a psychiatric acute care service was used. Patients were divided into 3 groups based on their antipsychotic prescription history: oral only, LAI only, or both formulations at separate times throughout the study period.
Forty-seven patients met inclusion criteria. The average proportions of days with medication were 32%, 76%, and 75% for the oral, LAI, and both formulations groups, respectively ( < .001). For medication persistence, there were 32 patients (91%), 3 patients (75%), and 5 patients (63%) with at least 1 gap in therapy for the oral, LAI, and both formulations groups, respectively ( = .098). For acute care services, there was a median number of zero acute care visits for each of the 3 groups ( = .179). A post hoc subgroup analysis found medication adherence to be statistically different between the oral and LAI groups.
Long-acting injectable antipsychotics were associated with better adherence compared with oral antipsychotics in patients with early psychosis.
尽管有理论认为，与口服抗精神病药物相比，长效注射用（LAI）抗精神病药物更有可能提高依从性、减少治疗中断并预防复发，但关于这一问题的已发表证据很少，特别是在早期精神病患者中。
对2013年7月1日至2014年8月31日期间新诊断为精神病性障碍的患者进行了为期12个月的回顾性评估。主要结局是依从性和持续性。依从性通过服药天数比例来确定，持续性定义为药物治疗无中断。次要结局是使用精神科急性护理服务的次数。根据患者的抗精神病药物处方史将其分为3组：仅口服、仅长效注射用或在整个研究期间不同时间使用两种剂型。
47名患者符合纳入标准。口服、长效注射用和两种剂型组的平均服药天数比例分别为32%、76%和75%（<0.001）。对于药物持续性，口服、长效注射用和两种剂型组分别有32名患者（91%）、3名患者（75%）和5名患者（63%）至少有1次治疗中断（=0.098）。对于急性护理服务，3组的急性护理就诊中位数均为零（=0.179）。事后亚组分析发现口服组和长效注射用组之间的药物依从性在统计学上存在差异。
在早期精神病患者中，与口服抗精神病药物相比，长效注射用抗精神病药物与更好的依从性相关。
