Pae Chi-Un, Han Changsu, Bahk Won-Myong, Lee Soo-Jung, Patkar Ashwin A, Masand Prakash S
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC, USA.
Clin Psychopharmacol Neurosci. 2021 May 31;19(2):233-242. doi: 10.9758/cpn.2021.19.2.233.
In a number of controlled clinical trials and naturalistic studies, aripiprazole once monthly (AOM) has been found to be effective and safe as acute and maintenance treatment options for schizophrenia. However, such clinical data have been presented in selected patient population (i.e., antipsychotic monotherapy, etc.), in particular, clinical information on switching to AOM from antipsychotic polypharmacy and/or other long acting injectable antipsychotics (LAIs) has been scarce till today.
The study period was from the first switching day to AOM up to 12 months in patients with antipsychotic polypharmacy (APpoly)/LAIs (baseline, month 3, month 6, and month 12). Available demographics and clinical information were retrieved from electronic medical records (EMRs). Available scores of Global Assessment of Functioning (GAF), Clinical Global Impression-Clinical Benefit (CGI-CB), CGI-severity, Visual Analog Scale on Satisfaction-Patient/Health Professional (VAS-P/HP), and the Positive and Negative Syndrome Scale-Insigh (PANSS-I) scores were also taken from EMR. Proportional change of functional impairment before and after AOM was also captured.
Data of 18 patients were available. Most commonly used combined APs before AOM were aripiprazole, blonanserin, quetiapine, and risperidone. At least 2 APs (n = 2.4) were combined before AOM. Scores of GAF (10.7% increase), CGI-CB (46.2% decrease), VAS-P (47.8% increase), VAS-HP (40.8% increase), and PANSS-I (27.9% increase) (all p = 0.001) were significantly improved from baseline to month 12, respectively. Approximately 59% of patients improved individual functioning with different level (i.e., employment, back to school, etc.) after AOM treatment at month 12.
The present study have clearly shown the clinical benefit and utility of switching to AOM for treatment of patients with APpoly/LAIs in routine practice. Subsequent, adequately-powered, well-controlled clinical trials may be necessary to confirm our findings in near future.
在多项对照临床试验和自然主义研究中，已发现阿立哌唑每月一次（AOM）作为精神分裂症的急性和维持治疗选择是有效且安全的。然而，此类临床数据是在特定患者群体（即抗精神病药物单药治疗等）中呈现的，特别是关于从抗精神病药物联合治疗和/或其他长效注射用抗精神病药物（LAIs）转换为AOM的临床信息至今仍很稀缺。
研究期为抗精神病药物联合治疗（APpoly）/LAIs患者从首次转换为AOM之日起至12个月（基线、第3个月、第6个月和第12个月）。从电子病历（EMR）中检索可用的人口统计学和临床信息。还从EMR中获取了功能总体评定量表（GAF）、临床总体印象-临床获益（CGI-CB）、CGI-严重程度、患者/健康专业人员满意度视觉模拟量表（VAS-P/HP）以及阳性和阴性症状量表-洞察力（PANSS-I）的可用评分。还记录了AOM前后功能损害的比例变化。
有18例患者的数据可用。AOM之前最常用的联合抗精神病药物是阿立哌唑、布南色林、喹硫平和利培酮。AOM之前至少联合使用了2种抗精神病药物（n = 2.4）。从基线到第12个月，GAF评分（增加10.7%）、CGI-CB评分（降低46.2%）、VAS-P评分（增加47.8%）、VAS-HP评分（增加40.8%）和PANSS-I评分（增加27.9%）（所有p = 0.001）均有显著改善。在第12个月接受AOM治疗后，约59%的患者在不同程度上改善了个人功能（即就业、返校等）。
本研究清楚地表明了在常规实践中，将APpoly/LAIs患者转换为AOM治疗的临床获益和实用性。随后，可能需要进行足够样本量、良好对照的临床试验，以便在不久的将来证实我们的发现。
