School of Health Care Administration, College of Management, Taipei Medical University, No. 172-1, Section 2, Keelung Road, Taipei 106, Taiwan.
Chiayi Branch, Taichung Veterans General Hospital, No. 600, Section 2, Shixian Road, West District, Chiayi City60090, Taiwan.
Eur Psychiatry. 2021 Dec 13;65(1):e5. doi: 10.1192/j.eurpsy.2021.2258.
Long-acting injectable (LAI) antipsychotics improve medication adherence in patients with schizophrenia and extend the duration of therapeutic drug levels but with administration of an increased dose. Real-world mortality data in patients prescribed LAIs are lacking. We conducted a population-based cohort study to estimate and compare the incidence rates of all-cause death and completed suicide in patients with schizophrenia/schizoaffective disorder exposed to LAIs and oral antipsychotics.
Patients with a diagnosis of schizophrenia/schizoaffective disorder between January 1, 2015 and November 30, 2019 were enrolled from the Taiwan National Health Insurance Research Database and linked to Death Registry records. Eligible patients were new antipsychotic users. Relative risks of death for each antipsychotic compared with oral paliperidone were evaluated using a Cox proportional hazard model adjusted for age, sex, Charlson Comorbidity Index, index year, bipolar or major depressive or other mood disorders, mental disorders due to drug use, and baseline hospitalization frequency.
There were 228,791.08 person-years of follow-up (mean 2.48 years). The incidence rates of all-cause death in users of LAI paliperidone administered monthly (PP1M) and every 3 months (PP3M) were 7.40/1,000 person-years (95% confidence interval 5.94-9.11) and 9.93 (5.88-15.79), respectively. The incidences of completed suicide were 2.03/1,000 person-years (1.32-2.99) and 3.10 (1.14-6.88), respectively. No significant associations were observed between PP1M and PP3M compared to oral paliperidone in incidences of all-cause death or for completed suicide.
No increased risk of all-cause death or completed suicide was observed in users of antipsychotic LAIs, including PP1M and PP3M.
长效注射（LAI）抗精神病药可提高精神分裂症患者的药物依从性，并延长治疗药物水平的持续时间，但需要增加剂量。目前缺乏接受 LAI 治疗的患者的实际死亡率数据。我们进行了一项基于人群的队列研究，以估计和比较接受 LAI 和口服抗精神病药治疗的精神分裂症/分裂情感障碍患者的全因死亡率和完全自杀率。
从台湾全民健康保险研究数据库中招募了 2015 年 1 月 1 日至 2019 年 11 月 30 日期间患有精神分裂症/分裂情感障碍的患者，并与死亡登记记录相关联。合格的患者为新的抗精神病药物使用者。使用 Cox 比例风险模型评估与口服帕利哌酮相比，每种抗精神病药物的死亡相对风险，该模型调整了年龄、性别、Charlson 合并症指数、指数年、双相或重度抑郁或其他心境障碍、药物使用引起的精神障碍以及基线住院频率。
共随访 228,791.08 人年（平均 2.48 年）。每月（PP1M）和每 3 个月（PP3M）给予 LAI 帕利哌酮的使用者的全因死亡率分别为 7.40/1,000 人年（95%置信区间 5.94-9.11）和 9.93（5.88-15.79）。完全自杀的发生率分别为 2.03/1,000 人年（1.32-2.99）和 3.10（1.14-6.88）。与口服帕利哌酮相比，PP1M 和 PP3M 与全因死亡率或完全自杀的发生率均无显著关联。
接受抗精神病药 LAI 治疗的患者，包括 PP1M 和 PP3M，未观察到全因死亡或完全自杀风险增加。
