1 King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK.
2 National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, London, UK.
J Psychopharmacol. 2019 Apr;33(4):449-458. doi: 10.1177/0269881118817387. Epub 2019 Jan 8.
Insight into the effect of clozapine is limited by a lack of controlling for confounding variables in current research. Our objective was to investigate the association between clozapine prescribed at discharge, following an inpatient episode, and risk of readmission into secondary mental health services in patients with schizophrenia and schizoaffective disorder, controlling extensively for confounding variables.
Clinical records from 3651 patients were analysed in a retrospective observational cohort study. Cox proportional-hazards regression models were used to assess the risk of hospital readmission. A series of sensitivity analyses were also conducted. Propensity score methods were used to address confounding-by-indication.
Patients on clozapine ( n=202) had a reduced risk of readmission compared with patients on other antipsychotics (adjusted hazard ratio=0.79; 95% confidence interval: 0.64-0.99; p=0.043). Clozapine also had a protective effect on risk of readmission when compared with olanzapine (adjusted hazard ratio 0.76; 95% confidence interval: 0.60-0.96; p=0.021). The effect size remained consistent after adjusting for an array of possible confounders, as well as using propensity scores to address confounding-by-indication. A statistically significant result was also noted in all but two sensitivity analyses.
Our findings suggest that clozapine is associated with a reduced risk of readmission into secondary mental health services.
目前的研究由于缺乏对混杂变量的控制，对氯氮平的作用了解有限。我们的目的是在控制了广泛的混杂变量的情况下，研究精神分裂症和分裂情感障碍患者在住院期间开出的氯氮平与随后在二级精神卫生服务机构再次入院的风险之间的关系。
在一项回顾性观察队列研究中，对 3651 名患者的临床记录进行了分析。使用 Cox 比例风险回归模型评估了住院再入院的风险。还进行了一系列敏感性分析。采用倾向评分法来解决混杂因素。
与使用其他抗精神病药物的患者相比（调整后的危险比=0.79；95%置信区间：0.64-0.99；p=0.043），使用氯氮平的患者再入院的风险降低。与奥氮平相比，氯氮平对再入院风险也有保护作用（调整后的危险比 0.76；95%置信区间：0.60-0.96；p=0.021）。在调整了一系列可能的混杂因素后，以及使用倾向评分来解决混杂因素后，该效果大小仍然一致。除了两项敏感性分析外，其他所有分析均得出了统计学显著的结果。
我们的研究结果表明，氯氮平与二级精神卫生服务机构的再入院风险降低相关。
