抗精神病药治疗早期个体症状改善可预测阿尔茨海默病神经精神症状的后续治疗反应：CATIE-AD 研究再分析。

Early Improvements of Individual Symptoms With Antipsychotics Predict Subsequent Treatment Response of Neuropsychiatric Symptoms in Alzheimer's Disease: A Re-Analysis of the CATIE-AD Study.

机构信息

Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8471, Japan.

Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.

出版信息

J Clin Psychiatry. 2020 Feb 11;81(2):19m12961. doi: 10.4088/JCP.19m12961.

DOI:10.4088/JCP.19m12961

PMID:32074412

Abstract

OBJECTIVE

The aim of the present study was to identify individual symptoms whose early improvements contributed to subsequent treatment response to antipsychotics for neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease (AD) using the dataset of the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD).

METHODS

The CATIE-AD study was conducted between April 2001 and November 2004 at 45 sites in the United States. Data for 421 patients with DSM-IV AD with NPSs treated with antipsychotics were analyzed in the present study. Treatment response was defined as a reduction of ≥ 9 points in the Neuropsychiatric Inventory (NPI) score or a reduction of ≥ 25% from baseline in Brief Psychiatric Rating Scale (BPRS) total score at week 8. Logistic regression analyses were performed to examine associations between response and clinical and demographic characteristics, including each total or individual symptom score reduction at week 2.

RESULTS

Reduction in NPI or BPRS total score at week 2 and several individual symptom score reductions (euphoria/elation, irritability, hallucinations, anxiety, agitation, apathy, disinhibition, and depression among NPI subitems; excitement, suspiciousness, disorientation, hostility, depressive mood, and emotional withdrawal among BPRS subitems) at week 2 were significantly associated with subsequent treatment response at week 8 (all P values < .05); Early non-improvements of irritability and suspiciousness were shown to be especially influential clinical markers in predicting subsequent treatment nonresponse. Furthermore, healthier condition at baseline was significantly associated with treatment response at week 8 (P < .05).

CONCLUSIONS

Although further research to validate these preliminary findings is needed, focusing on early improvements of individual symptoms could help identify subsequent treatment responders to antipsychotics in AD patients with NPSs.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00015548.

摘要

目的

本研究旨在利用《临床抗精神病药物干预疗效-阿尔茨海默病（CATIE-AD）研究》的数据，确定个体症状的早期改善对阿尔茨海默病（AD）患者神经精神症状（NPSs）抗精神病药物治疗反应的后续影响。

方法

CATIE-AD 研究于 2001 年 4 月至 2004 年 11 月在美国 45 个地点进行。本研究分析了 421 例接受抗精神病药物治疗的符合 DSM-IV AD 伴 NPSs 患者的数据。治疗反应定义为在第 8 周时神经精神病学问卷（NPI）评分降低≥9 分，或简明精神病评定量表（BPRS）总分降低≥25%。进行逻辑回归分析以检查反应与临床和人口统计学特征之间的关系，包括第 2 周时的每个总症状或个体症状评分降低。

结果

第 2 周时 NPI 或 BPRS 总分降低，以及第 2 周时 NPI 亚项中的几个个体症状评分降低（欣快/兴奋、易激惹、幻觉、焦虑、激越、淡漠、失抑制和抑郁；BPRS 亚项中的兴奋、怀疑、定向障碍、敌意、抑郁情绪和情感退缩）与第 8 周时的后续治疗反应显著相关（所有 P 值均<.05）；易激惹和怀疑的早期无改善被证明是预测后续治疗无反应的特别有影响的临床标志物。此外，基线时的健康状况与第 8 周时的治疗反应显著相关（P<.05）。