Nakonezny Paul A, Lindow Janet C, Stroup T Scott, McEvoy Joseph P, Swartz Marvin S, Rosenheck Robert A, Byerly Matthew J
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Department of Psychiatry, University of Arizona, Biomedical Research Foundation of Southern Arizona, and Southern Arizona VA Health Care System, Tucson, AZ 85723, USA.
Schizophr Res. 2020 Jun;220:92-97. doi: 10.1016/j.schres.2020.03.053. Epub 2020 Apr 5.
To determine if a single baseline adherence assessment (Brief Adherence Rating Scale [BARS]) could identify patients who are likely to respond to long-acting injectable (LAI) antipsychotic treatment.
The current secondary analysis included a sub-sample of adult outpatients (N = 176) with schizophrenia or schizoaffective disorder who participated in the "A Comparison of Long-Acting Injectable Medications for Schizophrenia (ACLAIMS)" trial and had a baseline BARS assessment and a baseline and month 3 Positive and Negative Syndrome Scale (PANSS) rating. The main outcome was LAI treatment response, defined as a ≥ 20% decrease (baseline to month 3) on the PANSS total score. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analysis was conducted to determine the optimal cutpoint of baseline BARS adherence in discriminating LAI treatment response at month 3. A logistic mixed model estimated the odds of response to LAI treatment at month 3 from the optimal baseline BARS cutpoint.
The ROC analysis determined that the single baseline BARS rating (cutoff ≤66%), indicating low adherence, best discriminated patients likely to respond to LAI treatment (AUC = 0.603, SE = 0.046, 95% binomial exact CI = 0.527 to 0.676, p = 0.025), with 38% sensitivity and 85% specificity. The logistic mixed model analysis revealed that patients with ≤66% BARS adherence had 3.464 times the predicted odds (95% CI = 1.604 to 7.480, p = 0.001) of responding to LAI treatment than those who were >66% BARS adherent.
A single baseline BARS assessment discriminated response to LAI treatment suggesting it is a reasonable tool to identify candidates for LAI antipsychotic treatment.
确定单次基线依从性评估（简明依从性评定量表 [BARS]）能否识别可能对长效注射（LAI）抗精神病药物治疗有反应的患者。
当前的二次分析纳入了参与“精神分裂症长效注射药物比较（ACLAIMS）”试验的成年门诊患者子样本（N = 176），这些患者患有精神分裂症或分裂情感性障碍，有基线BARS评估以及基线和第3个月的阳性与阴性症状量表（PANSS）评分。主要结局是LAI治疗反应，定义为PANSS总分从基线到第3个月下降≥20%。进行了受试者操作特征（ROC）和曲线下面积（AUC）分析，以确定在区分第3个月LAI治疗反应时基线BARS依从性的最佳切点。逻辑混合模型从最佳基线BARS切点估计了第3个月对LAI治疗有反应的几率。
ROC分析确定，单次基线BARS评分（临界值≤66%）表明依从性低，能最好地区分可能对LAI治疗有反应的患者（AUC = 0.603，SE = 0.046，95%二项式精确CI = 0.527至0.676，p = 0.025），敏感性为38%，特异性为85%。逻辑混合模型分析显示，BARS依从性≤66%的患者对LAI治疗有反应的预测几率是BARS依从性>66%患者的3.464倍（95% CI = 1.604至7.480，p = 0.001）。
单次基线BARS评估可区分对LAI治疗的反应，表明它是识别LAI抗精神病药物治疗候选者的合理工具。
