Wagner Elias, Oviedo-Salcedo Tatiana, Pelzer Nicola, Strube Wolfgang, Maurus Isabel, Gutwinski Stefan, Schreiter Stefanie, Kleymann Phillip, Morgenroth Carla-Lou, Okhuijsen-Pfeifer Cynthia, Luykx Jurjen J, Falkai Peter, Schneider-Axmann Thomas, Hasan Alkomiet
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany.
Pharmacopsychiatry. 2020 Nov;53(6):273-283. doi: 10.1055/a-1208-0045. Epub 2020 Aug 5.
Even though clozapine is the recommended last-resort antipsychotic, many patients fail to respond and show treatment-refractory psychotic symptoms. Smoking has been suggested as a possible risk factor for poor clozapine response, hampering remission and negatively impacting somatic outcomes.
Our aim was to test whether smoking status is associated with remission rates and other symptomatic and somatic outcomes. We therefore assessed remission rates according to The Remission in Schizophrenia Working Group (RSWG) criteria, and metabolic and cognitive outcomes among patients with schizophrenia-spectrum disorders treated with clozapine for at least 6 months. For analyses, we grouped our cohort into 3 groups according to clozapine treatment duration (6 months, 2 years, 5 years).
One hundred five patients were included in our analyses and grouped according to their clozapine treatment duration. In the 6-months analyses, patients who smoked were significantly more likely to be younger of age (p=0.002) despite on average shorter duration of clozapine treatment (p=0.041) and significantly more likely to be treated with mood-stabilizing co-medication (p=0.030) compared to nonsmokers. Remission rates (p=0.490), as well as a set of metabolic and cognitive variables did not differ between the 2 groups. A related pattern could be observed for the 2- and 5-years analyses.
Smoking behavior among clozapine-treated schizophrenia patients might delineate a cohort with an earlier onset of the disease. Nevertheless, most findings comparing disease-specific and clinical outcomes among smokers and nonsmokers were negative. Further research is needed to identify strategies to overcome insufficient remission rates in this patient group.
尽管氯氮平是推荐的最后一线抗精神病药物，但许多患者对此无反应，并表现出难治性精神病症状。吸烟被认为是氯氮平反应不佳的一个可能风险因素，会阻碍病情缓解并对躯体预后产生负面影响。
我们的目的是检验吸烟状况是否与缓解率以及其他症状性和躯体性预后相关。因此，我们根据精神分裂症缓解工作组（RSWG）标准评估了缓解率，并对接受氯氮平治疗至少6个月的精神分裂症谱系障碍患者的代谢和认知预后进行了评估。为了进行分析，我们根据氯氮平治疗时长将队列分为3组（6个月、2年、5年）。
105名患者纳入我们的分析，并根据氯氮平治疗时长进行分组。在6个月的分析中，与不吸烟者相比，吸烟患者年龄显著更小（p = 0.002），尽管氯氮平治疗平均时长较短（p = 0.041），且接受心境稳定剂联合用药的可能性显著更高（p = 0.030）。两组之间的缓解率（p = 0.49）以及一系列代谢和认知变量并无差异。在2年和5年的分析中也观察到了类似模式。
接受氯氮平治疗的精神分裂症患者中的吸烟行为可能描绘出一组疾病发病较早的人群。然而，大多数比较吸烟者和不吸烟者之间疾病特异性和临床预后的结果均为阴性。需要进一步研究以确定克服该患者群体缓解率不足的策略。
