Int J Clin Pharmacol Ther. 2021 Apr;59(4):298-307. doi: 10.5414/CP203814.
Metabolic side effects of antipsychotics significantly affect adherence to medication. We aimed to identify factors associated with the occurrence of metabolic diseases among Korean patients with schizophrenia (SCZ) from the national health insurance system database. We evaluated the frequency of antidiabetic and antihyperlipidemic use after diagnosis of SCZ according to typical or atypical antipsychotic use.
Among the 43,800 patients diagnosed with SCZ between 2008 and 2012, 29,591 patients who had no metabolic diseases before the diagnosis were included in the analysis to investigate the occurrence of metabolic diseases associated with antipsychotic use. The associations between the development of metabolic diseases and patient characteristics were evaluated using logistic regression analysis.
Use of both typical and atypical antipsychotics (multivariate-adjusted odds ratio (OR), 1.2513; 95% confidence interval (CI), 1.0953 - 1.4294) was associated with higher incidence of metabolic diseases than without their use. Among the atypical antipsychotics, use of clozapine (multivariate-adjusted OR, 1.1959; 95% CI, 1.0086 - 1.4179) and quetiapine (multivariate-adjusted OR, 1.1284; 95% CI, 1.0446 - 1.2189) showed higher incidence of metabolic diseases compared to that without their use. Among the patients using ≥ 1 type of antidiabetic or antihyperlipidemic agents within 6 years after diagnosis of SCZ, the proportion of patients using only atypical antipsychotics was greater than those using only typical antipsychotics.
The use of both typical and atypical antipsychotics, and clozapine and quetiapine treatment, may be associated with the occurrence of metabolic diseases in patients with SCZ. Additional prospective studies with accurate dosage information are needed to validate our findings.
抗精神病药物的代谢副作用会显著影响患者对药物的依从性。我们旨在从国家健康保险系统数据库中确定与韩国精神分裂症（SCZ）患者发生代谢疾病相关的因素。我们根据典型或非典型抗精神病药物的使用情况，评估了 SCZ 诊断后使用抗糖尿病和抗高血脂药物的频率。
在 2008 年至 2012 年间被诊断为 SCZ 的 43800 名患者中，纳入了 29591 名在诊断前无代谢疾病的患者进行分析，以调查与抗精神病药物使用相关的代谢疾病的发生情况。使用逻辑回归分析评估代谢疾病的发展与患者特征之间的关系。
与未使用抗精神病药物相比，使用典型和非典型抗精神病药物（多变量调整后的优势比（OR），1.2513；95%置信区间（CI），1.0953-1.4294）与更高的代谢疾病发生率相关。在非典型抗精神病药物中，与未使用相比，使用氯氮平（多变量调整后的 OR，1.1959；95%CI，1.0086-1.4179）和喹硫平（多变量调整后的 OR，1.1284；95%CI，1.0446-1.2189）与更高的代谢疾病发生率相关。在 SCZ 诊断后 6 年内使用≥1 种抗糖尿病或抗高血脂药物的患者中，使用仅非典型抗精神病药物的患者比例大于使用仅典型抗精神病药物的患者。
使用典型和非典型抗精神病药物、氯氮平和喹硫平治疗可能与 SCZ 患者发生代谢疾病有关。需要进行额外的前瞻性研究，以验证我们的发现并获得准确的剂量信息。
