预测帕利哌酮 3 个月长效注射剂复发和治疗中断的因素：一项为期 2 年的自然随访研究。

Factors predicting relapse and treatment discontinuation with paliperidone 3-monthly long-acting injection: A 2-year naturalistic follow-up study.

机构信息

Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, LondonSE5 8AZ, UK.

School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, LondonW12 7RH, UK.

出版信息

Eur Psychiatry. 2021 Oct 26;64(1):e68. doi: 10.1192/j.eurpsy.2021.2243.

BACKGROUND

Paliperidone 3-monthly (PP3M) long-acting injection has proven efficacy and effectiveness in schizophrenia. Little is known of its effectiveness in other diagnoses.

METHODS

All patients starting PP3M were followed up for 2 years. Main outcome measures were relapse and discontinuation from PP3M. Post hoc we examined outcomes in those switched back to one monthly paliperidone (PP1M) long-acting injection.

RESULTS

Overall, 186 patients were followed-up. At the 2-year end point, 110 patients (59%) were still receiving PP3M, and 129 (70%) were receiving some form of paliperidone long-acting injection. Discontinuation from paliperidone long-acting injections (PPLAIs) was more likely with a nonschizophrenia diagnosis (hazard ratio [HR] for continuation 0.429 [95% confidence intervals (CI) - 0.21, 0.87 p = 0.018)), and prior clozapine use [in PP3M patients; HR for discontinuation 1.87 [95% CI - 1.05, 3.30 p = 0.032]). Relapse occurred in 20 (11%) of those receiving PP3M. Relapse on PP3M and PPLAIs was more likely in nonschizophrenia diagnosis (HR 0.17 for remaining relapse-free [95% CI - 0.06, 0.50; p = 0.001]; HR 0.21 [95% CI - 0.08, 0.58 p = 0.002], respectively), polypharmacy in PP3M patients (HR for relapse 7.91 [95% CI - 3.73, 22.9; p < 0.001]) and PPLAI patients (HR for relapse 6.45 [95% CI - 2.49, 16.5; p < 0.001]), and prior clozapine use in PP3M patients (HR for relapse 6.11 [95% CI - 1.82, 20.5; p = 0.003]) and PPLAI patients (HR for relapse 4.52 (95% CI - 1.51, 13.5; p = 0.007).

CONCLUSIONS

Outcomes with PP3M are excellent in practice, even when used outside its formal license. PP3M was relatively more effective in those with an F20 schizophrenia diagnosis and in those never before considered for or prescribed clozapine.

背景

帕利哌酮 3 个月长效注射剂在精神分裂症中已被证明具有疗效和有效性。但其在其他诊断中的疗效知之甚少。

方法

所有开始使用帕利哌酮 3 个月长效注射剂的患者均随访 2 年。主要结局指标为复发和停用帕利哌酮 3 个月长效注射剂。事后分析我们检查了那些转回每月 1 次帕利哌酮（PP1M）长效注射剂的患者的结局。

结果

共有 186 名患者接受了随访。在 2 年终点时，110 名患者（59%）仍在接受帕利哌酮 3 个月长效注射剂治疗，129 名患者（70%）正在接受某种形式的帕利哌酮长效注射剂治疗。非精神分裂症诊断患者停用帕利哌酮长效注射剂（PPLAIs）的可能性更大（继续治疗的风险比[HR]为 0.429[95%置信区间（CI）0.21-0.87，p=0.018]），且既往使用氯氮平（在帕利哌酮 3 个月治疗的患者中；停药的 HR 为 1.87[95%CI-1.05-3.30，p=0.032]）。接受帕利哌酮 3 个月长效注射剂治疗的患者中有 20 名（11%）复发。非精神分裂症诊断的患者在帕利哌酮 3 个月和 PPLAIs 上的复发更常见（无复发的剩余 HR 为 0.17[95%CI-0.06-0.50，p=0.001]；HR 为 0.21[95%CI-0.08-0.58，p=0.002]），PP3M 患者的多药治疗（复发的 HR 为 7.91[95%CI-3.73-22.9，p<0.001]）和 PPLAI 患者（复发的 HR 为 6.45[95%CI-2.49-16.5，p<0.001]），以及 PPLAI 患者（复发的 HR 为 4.52[95%CI-1.51-13.5，p=0.007]）。PP3M 患者的氯氮平使用（复发的 HR 为 6.11[95%CI-1.82-20.5，p=0.003]）和 PPLAI 患者（复发的 HR 为 4.52[95%CI-1.51-13.5，p=0.007]）。