Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Psychol Med. 2023 Jan;53(1):181-188. doi: 10.1017/S0033291721001379. Epub 2021 Apr 15.
Current evidence on antipsychotic treatment and risk of psychiatric hospitalization in first-episode schizophrenia (FES) is largely based on the findings from randomized clinical trials (RCTs). However, the generalization of the findings to real-world patients is limited due to inherent caveats of the RCT. We aimed to investigate the treatment discontinuation and risk of psychiatric hospitalization using a nationwide population database.
The Health Insurance Review Agency database in South Korea was obtained, and the observation period started from 1 January 2009 to 31 December 2016. We defined the maintenance period as the period from 6-month after the diagnosis of schizophrenia, which is utilized for the main results. For a total of 44 396 patients with FES, a within-individual Cox regression model was used to compare the risk of the treatment discontinuation and psychiatric hospitalization.
In group comparison, a long-acting injectable (LAI) antipsychotic group was associated with the lowest risk of the treatment discontinuation (0.64, 0.55-0.75) and psychiatric hospitalization (0.29, 0.22-0.38) in comparison with a typical antipsychotic group and no use, respectively. Among individual antipsychotics, the lowest risk of the treatment discontinuation was observed in LAI paliperidone (0.46, 0.37-0.66) compared to olanzapine. Clozapine was found to be the most effective antipsychotic in lowering the risk of psychiatric hospitalization as monotherapy compared to no use (0.23, 0.18-0.31).
In real-world patients with FES, LAI paliperidone and clozapine were associated with low treatment discontinuation and better effectiveness in lowering the risk of psychiatric hospitalization.
目前关于首发精神分裂症（FES）患者抗精神病药物治疗与精神病住院风险的证据主要基于随机临床试验（RCT）的结果。然而，由于 RCT 固有的局限性，这些研究结果在真实世界患者中的推广受到限制。本研究旨在利用全国性人群数据库调查抗精神病药物治疗中断和精神病住院风险。
本研究从韩国健康保险审查与评估服务数据库中获取数据，观察期从 2009 年 1 月 1 日至 2016 年 12 月 31 日。我们将维持期定义为从精神分裂症确诊后 6 个月，用于主要结果分析。对于 44396 例 FES 患者，采用个体内 Cox 回归模型比较抗精神病药物治疗中断和精神病住院风险。
在组间比较中，与典型抗精神病药物相比，长效注射（LAI）抗精神病药物组的治疗中断风险最低（0.64，0.55-0.75），精神病住院风险也最低（0.29，0.22-0.38）；与未使用抗精神病药物相比，LAI 帕利哌酮（0.46，0.37-0.66）的治疗中断风险最低。与未使用抗精神病药物相比，氯氮平作为单一疗法降低精神病住院风险的效果最佳（0.23，0.18-0.31）。
在 FES 真实世界患者中，LAI 帕利哌酮和氯氮平的治疗中断率较低，降低精神病住院风险的效果较好。
