Fulone Izabela, Silva Marcus Tolentino, Lopes Luciane Cruz
Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil.
Front Pharmacol. 2021 May 31;12:638001. doi: 10.3389/fphar.2021.638001. eCollection 2021.
Switching between second-generation antipsychotics (SGAs) is a common clinical practice in the treatment of schizophrenia and schizoaffective disorders due to differences in the drugs' tolerability and safety profiles as well as the challenge of obtaining an ideal response. However, the factors associated with SGA switching remain uncertain and related real-world data are scarce. The main objective was to identify the factors associated with the switching of SGAs in patients with schizophrenia or schizoaffective disorder. We conducted a retrospective cohort study of outpatients with schizophrenia or schizoaffective disorder, who were aged ≥18 years and received a SGA (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a Brazilian pharmaceutical assistance program for at least 3 months. We identified SGA users from 2008 to 2017 by using a national administrative database (Ambulatory Information System-SIA/SUS). The factors associated with the switches were evaluated by Cox proportional hazards regression and adjusted for sex and age; the confidence interval was set at 95% (95% CI). In total, 563,765 patients were included. Female sex, advanced age of ≥70 years, residence in the Brazilian northeast region, and the type of antipsychotic used were associated with an increased risk of switching ( < 0.001). The incidence of switching ranged from 37.6/100 person-years for clozapine users to 58.2/100 person-years for risperidone users. Compared to the adjusted hazard ratio, for clozapine users, the corresponding ratios for risperidone, ziprasidone, quetiapine and olanzapine were 1.59 (95% CI, 1.57-1.61), 1.41 (95% CI, 1.39-1.44), 1.25 (95% CI, 1.23-1.26) and 1.11 (95% CI, 1.10-1.12) respectively. The groups most susceptible to SGA switching in real-life setting were older individuals, women, and those living in the Brazilian northeast region. Risperidone was associated with the highest risk of switching and as expected, clozapine was associated with the lowest risk of switching than that associated with the other SGAs.
由于第二代抗精神病药物（SGA）在耐受性、安全性方面存在差异，以及获得理想疗效面临挑战，因此在精神分裂症和分裂情感性障碍的治疗中，更换SGA是一种常见的临床做法。然而，与更换SGA相关的因素仍不明确，且相关的真实世界数据稀缺。主要目的是确定精神分裂症或分裂情感性障碍患者更换SGA的相关因素。我们对年龄≥18岁、从巴西药物援助项目中接受一种SGA（氯氮平、奥氮平、利培酮、喹硫平或齐拉西酮）至少3个月的精神分裂症或分裂情感性障碍门诊患者进行了一项回顾性队列研究。我们通过使用国家行政数据库（门诊信息系统 - SIA/SUS）确定了2008年至2017年期间的SGA使用者。通过Cox比例风险回归评估与换药相关的因素，并对性别和年龄进行了调整；置信区间设定为95%（95%CI）。总共纳入了563,765名患者。女性、年龄≥70岁、居住在巴西东北部地区以及所使用的抗精神病药物类型与换药风险增加相关（<0.001）。换药发生率从氯氮平使用者的37.6/100人年到利培酮使用者的58.2/人年不等。与调整后的风险比相比，对于氯氮平使用者，利培酮、齐拉西酮、喹硫平及奥氮平的相应比值分别为1.59（CI 95%，1.57 - 1.61）、1.41（CI 95%，1.39 - 1.44）、1.25（CI 95%，1.23 - 1.26）及1.11（CI 95%，1.10 - 1.12）。在现实生活环境中，最容易更换SGA的群体是老年人、女性以及居住在巴西东北部地区的人。利培酮与最高的换药风险相关，正如预期的那样，氯氮平与比其他SGA更低的换药风险相关。
