WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
CNS Drugs. 2021 Jun;35(6):655-665. doi: 10.1007/s40263-021-00809-w. Epub 2021 Mar 29.
Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses.
Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors.
The STAR Network 'Depot Study' was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively.
The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4-44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3-43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4-84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6-40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6-27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742-0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003-4.634; p = 0.049).
Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation.
最近的指南建议更广泛地使用长效注射抗精神病药（LAI），但关于 LAI 使用在停药率和相关因素方面的后果的自然主义数据仍然很少，这使得临床医生难以了解合理的治疗过程。
我们的目的是在真实临床环境下，评估首次处方后 12 个月内 LAI 的停药率、停药原因和相关因素。
STAR 网络“Depot 研究”是一项自然主义、多中心、前瞻性观察研究，纳入了无诊断、临床严重程度或环境限制的 LAI 起始患者。来自 32 个意大利中心的参与者在基线和 6 个月及 12 个月的随访时进行评估。使用简明精神病评定量表、药物态度量表和 Kemp 量表分别测量精神病理学、药物态度和治疗依从性。
该研究对 394 名参与者进行了 12 个月的随访。12 个月时的总体停药率为 39.3%（95%置信区间 [CI] 34.4-44.3），其中棕榈酸帕利哌酮 LAI 的停药率最低（33.9%；95% CI 25.3-43.5），奥氮平 LAI 的停药率最高（62.5%；95% CI 35.4-84.8）。最常见的停药原因是不良事件的发生（32.9%；95% CI 25.6-40.9），其次是患者拒绝用药（20.6%；95% CI 14.6-27.9）。基线时的药物依从性与停药风险呈负相关（风险比 [HR] 0.853；95% CI 0.742-0.981；p=0.026），而与棕榈酸帕利哌酮 LAI 相比，奥氮平 LAI 的处方与增加的停药风险相关（HR 2.156；95% CI 1.003-4.634；p=0.049）。
临床医生应意识到 LAI 停药是一种常见现象。应与患者仔细讨论 LAI 的选择，同时考虑个体特征和每种制剂的实际应用可能存在的障碍。
