Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan.
Seijin Hospital, Tokyo, Japan.
Asian J Psychiatr. 2022 Jan;67:102917. doi: 10.1016/j.ajp.2021.102917. Epub 2021 Nov 6.
To compare the real-world effectiveness of antipsychotic treatments focusing on long-acting injectable antipsychotic medications (LAIs) and antipsychotic polytherapies except polytherapy involving clozapine (APEC) for patients with schizophrenia.
This prospective study was conducted over a 19-month period in 12 psychiatric emergency hospitals in Japan. Patients who were newly admitted to psychiatric emergency wards between September 2019 and March 2020 because of acute onset or exacerbation of Schizophrenia and Other Psychotic Disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were included. All patients were followed for one-year after discharge or until March 31, 2021. The primary outcome was the risk of treatment failure defined as psychiatric rehospitalization, discontinuation of medication, death, or continuation of hospitalization for one year. Cox proportional hazards multivariate regression was used for analyses.
A total of 1011 patients were enrolled (women, 53.7%; mean [SD] age, 47.5 [14.8] years). During follow-up, 588 patients (58.2%) experienced treatment failure including rehospitalization (513 patients), discontinuation of medication (17 patients), death (11 patients), and continuation of hospitalization for one-year (47 patients). Switching to LAIs (hazard ratio [HR] 0.810, 95%CI 0.659-0.996) and APEC (HR 0.829, 95%CI 0.695-0.990) were significantly associated with a low rate of treatment failure.
Switching to LAIs and APEC in early non-responders seems to be beneficial for the prevention of treatment failure in acutely admitted patients with schizophrenia. The risk of treatment failure was about 19% and 17% lower in patients treated with LAIs and APEC, respectively, than in patients treated without them.
比较针对长效注射抗精神病药物（LAIs）和抗精神病药物联合治疗（APEC）的抗精神病药物治疗的真实世界疗效，除了涉及氯氮平的联合治疗（APEC）。
这是一项在日本 12 家精神科急诊医院进行的前瞻性研究，历时 19 个月。2019 年 9 月至 2020 年 3 月期间，因精神分裂症和其他精神障碍（根据精神障碍诊断与统计手册，第五版定义）急性发作或恶化而新入住精神科急诊病房的患者符合纳入标准。所有患者在出院后或 2021 年 3 月 31 日之前随访一年。主要结局是治疗失败的风险，定义为精神科再入院、停药、死亡或住院一年。采用 Cox 比例风险多变量回归进行分析。
共纳入 1011 例患者（女性，53.7%；平均[标准差]年龄，47.5[14.8]岁）。在随访期间，588 例患者（58.2%）经历了治疗失败，包括再入院（513 例）、停药（17 例）、死亡（11 例）和住院一年（47 例）。转换为 LAI（风险比[HR]0.810，95%可信区间[CI]0.659-0.996）和 APEC（HR 0.829，95%CI 0.695-0.990）与低治疗失败率显著相关。
在早期无反应者中转换为 LAI 和 APEC 似乎有利于预防急性入院精神分裂症患者的治疗失败。与未接受 LAI 和 APEC 治疗的患者相比，接受 LAI 和 APEC 治疗的患者治疗失败的风险分别降低了约 19%和 17%。
