Epidemiology, Janssen Research and Development, Titusville, NJ, USA.
Peking University Sixth Hospital (Institute of Mental Health), Beijing, China.
Aust N Z J Psychiatry. 2018 Dec;52(12):1202-1212. doi: 10.1177/0004867418805559. Epub 2018 Oct 12.
Although antipsychotic monotherapy is recommended as the main treatment for schizophrenia, antipsychotic polypharmacy is not rare in practice. However, longitudinal data on antipsychotic polypharmacy in schizophrenia treatment are limited.
This longitudinal database study described antipsychotic polypharmacy in the treatment of schizophrenia in real-world settings in China and Japan. We retrieved information about antipsychotic treatment for schizophrenia from January 2010 to December 2014 from two hospital Electronic Medical Records databases in China and one claims database, Japan Medical Data Centre in Japan. Eligible patients had a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision F20.x) and at least one prescription for first or second generation antipsychotics. Antipsychotic polypharmacy was defined as having more than one antipsychotic medication overlapping for ⩾60 days. The Japan Medical Data Centre study cohort was further stratified by employees (insurance beneficiaries) and their dependents.
The study cohorts comprised 11,961 patients from China and 25,034 (10,661 employee sub-cohort and 14,373 dependent sub-cohort) from 14 days Japan Medical Data Centre in Japan. Most patients were prescribed monotherapy (87.3% in China and 80.1% in Japan), of which oral second-generation antipsychotics were the majority (78.9% in China and 65.8% in Japan). The prevalence rate of antipsychotic polypharmacy was 12.7% in China and 19.9% in Japan (13.7% in employees vs 24.5% in dependents). The most common combinations were two oral antipsychotics. Combinations of more than two drugs were uncommon in China (0.3%) but were prescribed for 5.3% of patients in Japan. Among patients treated with monotherapy, 12.6/100 person-years (11.8%) in China and 9.6/100 person-years (11.0%) in Japan switched to antipsychotic polypharmacy during follow-up. Younger patients were more likely to switch to antipsychotic polypharmacy than older patents in all study cohorts.
The observed rates of antipsychotic polypharmacy ranged from 12.7% in China to 19.9% in Japan. Switching from monotherapy to antipsychotic polypharmacy was most likely to occur in younger patients with schizophrenia.
尽管抗精神病药单药治疗被推荐为精神分裂症的主要治疗方法，但在实践中，抗精神病药联合用药并不少见。然而，关于精神分裂症治疗中抗精神病药联合用药的纵向数据有限。
本纵向数据库研究描述了中国和日本真实环境中精神分裂症治疗中的抗精神病药联合用药情况。我们从中国的两个医院电子病历数据库和日本的日本医疗数据中心检索了 2010 年 1 月至 2014 年 12 月期间治疗精神分裂症的抗精神病药物信息。合格患者的诊断为精神分裂症（国际疾病分类，第十版 F20.x），且至少有一次处方为第一代或第二代抗精神病药物。抗精神病药联合用药定义为同时使用两种以上重叠使用 ⩾60 天的抗精神病药物。日本医疗数据中心的研究队列还根据员工（保险受益人）及其家属进行分层。
研究队列包括来自中国的 11961 例患者和来自日本医疗数据中心的 25034 例患者（员工亚队列 10661 例，家属亚队列 14373 例）。大多数患者接受单药治疗（中国 87.3%，日本 80.1%），其中口服第二代抗精神病药占大多数（中国 78.9%，日本 65.8%）。中国抗精神病药联合用药的患病率为 12.7%，日本为 19.9%（员工为 13.7%，家属为 24.5%）。最常见的联合用药是两种口服抗精神病药。在中国，联合使用三种以上药物的情况很少见（0.3%），但在日本，有 5.3%的患者接受了这种治疗。在接受单药治疗的患者中，中国有 12.6/100 人年（11.8%）和日本有 9.6/100 人年（11.0%）在随访期间转为抗精神病药联合用药。所有研究队列中，年轻患者比老年患者更有可能转为抗精神病药联合用药。
观察到的抗精神病药联合用药率在中国为 12.7%，在日本为 19.9%。从单药治疗转为抗精神病药联合用药最有可能发生在年轻的精神分裂症患者中。
