Alkermes, Inc, Waltham, Massachusetts, USA.
The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd St, Glen Oaks, NY 11004.
J Clin Psychiatry. 2020 Mar 17;81(2):19m12731. doi: 10.4088/JCP.19m12731.
Patients with schizophrenia and comorbid alcohol use disorder remain understudied. This post hoc analysis evaluated data from Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia study (January 2001-December 2004).
Patients without substance abuse (except marijuana use) in the month before study entry were categorized into those with a history of alcohol use disorder (SZ + AUD) within 5 years before study entry and those without alcohol use disorder (SZ-only) per DSM-IV criteria. Time to first and recurrent exacerbations and hospitalizations were compared between disease states and between olanzapine and perphenazine, quetiapine, risperidone, and ziprasidone.
A total of 1,338 patients (SZ + AUD = 22.6%; SZ-only = 77.4%) were included. Time to first exacerbation of SZ was significantly shorter in the SZ + AUD versus SZ-only population (median = 5.4 vs 6.4 months; hazard ratio [HR] = 1.20 [95% CI, 1.01-1.42]; P = .039). Similar findings were observed for first hospitalization (HR = 1.63 [95% CI, 1.20-2.22]; P = .002) and recurrent hospitalizations (HR = 1.60 [95% CI, 1.18-2.15]; P = .002). The most common reasons leading to exacerbation in both groups were an increase in symptom severity and lack of efficacy. In patients with SZ + AUD related or unrelated to marijuana, perphenazine, quetiapine, risperidone, and ziprasidone were associated with significantly shorter time to first exacerbation versus olanzapine.
This post hoc analysis confirmed that patients with SZ + AUD had a worse illness course than patients with SZ-only and suggests that olanzapine may be associated with a longer time to first and recurrent exacerbations versus other antipsychotics in this difficult-to-treat population. Further research is needed to identify effective treatments for this important yet understudied patient population.
ClinicalTrials.gov identifier: NCT00014001.
伴有共病酒精使用障碍的精神分裂症患者研究仍较少。本事后分析评估了精神分裂症临床干预疗效试验（Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia，CATIE）研究 1 期的数据（2001 年 1 月至 2004 年 12 月）。
无研究入组前 1 个月物质滥用史（除大麻使用外）的患者，根据 DSM-IV 标准分为研究入组前 5 年内有酒精使用障碍史（SZ+AUD）和无酒精使用障碍史（SZ-only）的患者。比较疾病状态、奥氮平与氟哌啶醇、喹硫平、利培酮和齐拉西酮之间首次和复发性恶化及住院的时间。
共纳入 1338 例患者（SZ+AUD=22.6%，SZ-only=77.4%）。SZ+AUD 患者的首次精神分裂症恶化时间显著短于 SZ-only 患者（中位数=5.4 个月比 6.4 个月；风险比[HR]为 1.20[95%置信区间，1.01-1.42]；P=0.039）。首次住院（HR=1.63[95%置信区间，1.20-2.22]；P=0.002）和复发性住院（HR=1.60[95%置信区间，1.18-2.15]；P=0.002）也存在相似的发现。两组中导致恶化的最常见原因是症状严重度增加和疗效不佳。在伴有或不伴有大麻的 SZ+AUD 患者中，与奥氮平相比，氟哌啶醇、喹硫平、利培酮和齐拉西酮首次恶化时间显著缩短。
本事后分析证实，伴有 SZ+AUD 的患者疾病进程较 SZ-only 患者更差，提示奥氮平可能与这一难治疗人群的首次和复发性恶化时间较长有关。需要进一步研究以确定针对这一重要但研究较少的患者群体的有效治疗方法。
ClinicalTrials.gov 标识符：NCT00014001。
