Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
New Children's Hospital, Pediatric Research Center, Laboratory of Developmental Psychopathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Child Adolesc Psychopharmacol. 2021 Aug;31(6):421-429. doi: 10.1089/cap.2020.0095. Epub 2021 Mar 18.
Despite the increasing use of antipsychotic drugs in children and adolescents in many countries, little is known about the treatment duration in this vulnerable population. The present nationwide study investigated the duration of antipsychotic treatment and factors associated with treatment discontinuation in Finnish children and adolescents. All subjects aged 1-17 years who had started a second-generation antipsychotic (SGA) drug (risperidone, quetiapine, aripiprazole, or olanzapine) between January 2008 and December 2016 ( = 20,932) were extracted from the Finnish Prescription Registry and followed up until December 31, 2017. Treatment duration was calculated as the time between the initial purchase of medication and treatment discontinuation. Treatment was considered discontinued if the treatment-free gap was more than 270 days. The associations between explanatory factors and treatment discontinuation were analyzed with the Cox proportional hazards models. The mean and median treatment durations were 509 days (95% confidence interval [95% CI]: 500-517 days) and 317 days (95% CI: 306-325 days), respectively. The duration was shorter in girls than in boys ( < 0.001). Of all SGA users, 35.1% used antipsychotics less than 50 days and 16.0% used more than 600 days. Shorter treatment duration was associated with age groups of 7-12 and 13-15 years compared with 1-6 years (hazard ratio [HR]:1.23 [95% CI: 1.11-1.36]; HR: 1.35 [95% CI: 1.21-1.51], respectively) and initiating treatment with quetiapine or olanzapine compared with risperidone (HR: 1.18 [95% CI: 1.12-1.25]; HR: 1.66 [95% CI 1.46-1.88], respectively). Switching of SGA drug during treatment was associated with longer treatment duration (HR: 0.40 [95% CI: 0.38-0.43]). In children and adolescents, the mean treatment duration of SGAs was relatively long given that the majority of SGA use was off-label. Older age and initiating treatment with quetiapine were associated with earlier treatment discontinuation, whereas switching of antipsychotic drug during therapy increased the possibility of longer SGA use.
尽管在许多国家儿童和青少年使用抗精神病药物的情况越来越多，但对于这一弱势群体的治疗持续时间知之甚少。本全国性研究调查了芬兰儿童和青少年使用第二代抗精神病药物（SGA）（利培酮、喹硫平、阿立哌唑或奥氮平）的治疗持续时间和与停药相关的因素。从 2008 年 1 月至 2016 年 12 月（ = 20,932）期间开始使用第二代抗精神病药物（SGA）药物（利培酮、喹硫平、阿立哌唑或奥氮平）的所有 1-17 岁患者均从芬兰处方登记处提取，并随访至 2017 年 12 月 31 日。治疗持续时间计算为初始药物购买和停药之间的时间。如果治疗无药间隔超过 270 天，则认为治疗已停止。使用 Cox 比例风险模型分析解释因素与停药之间的关联。平均和中位数治疗持续时间分别为 509 天（95%置信区间[95%CI]：500-517 天）和 317 天（95%CI：306-325 天）。女孩的治疗时间短于男孩（ < 0.001）。所有 SGA 用户中，35.1%的人使用抗精神病药物的时间少于 50 天，16.0%的人使用时间超过 600 天。较短的治疗持续时间与 7-12 岁和 13-15 岁年龄组相比，与 1-6 岁年龄组（风险比[HR]：1.23[95%CI：1.11-1.36]；HR：1.35[95%CI：1.21-1.51]），与起始使用喹硫平或奥氮平相比，与起始使用利培酮相比（HR：1.18[95%CI：1.12-1.25]；HR：1.66[95%CI 1.46-1.88]）。治疗期间 SGA 药物的转换与治疗持续时间较长有关（HR：0.40[95%CI：0.38-0.43]）。在儿童和青少年中，鉴于大多数 SGA 的使用都是超适应证的，因此 SGA 的平均治疗持续时间相对较长。年龄较大和起始使用喹硫平与更早停药相关，而治疗期间抗精神病药物的转换增加了 SGA 更长时间使用的可能性。
