From the Department of Neuropsychiatry, Kurume University School of Medicine, Kurume City.
Elm-tree Mental Clinic, Ogori City.
J Clin Psychopharmacol. 2022;42(4):350-356. doi: 10.1097/JCP.0000000000001557. Epub 2022 May 4.
Lamotrigine (LTG) is used for treatment of mood disorders, but it is associated with the risk of rash occurrence in the initial administration phase. Although slow titration reduces this risk, its effectiveness in the treatment of mood disorders has not been verified. The effects of titration method on the safety and effectiveness of LTG for the treatment of mood disorders were examined in this study.
This retrospective cohort study included 312 patients with mood disorders who underwent initiation of LTG therapy. Data regarding baseline demographics, titration schedules, concomitant medications, and time to and cause of discontinuation of LTG were collected. A multivariate analysis was used to evaluate the effects of the titration schedules. The 12-month effectiveness was also evaluated.
The 12-month discontinuation rate of LTG was 16.7%. The most frequent cause of discontinuation was development of a rash (47.7%, n = 312). Fast titration (adjusted odds ratio, 8.15) significantly increased the risk of rash development, and slow titration (adjusted odds ratio, 0.29) significantly decreased this risk. The time to all-cause discontinuation was not significantly different between the slow and standard titration groups (n = 303). After 12 months of treatment, the condition of 46.7% patients were rated much or very much improved using CGI-C.
Although slow titration of LTG reduces the occurrence of a rash, it is not more effective than standard titration in the long term. Optimizing the initial LTG titration schedule for patients with mood disorders is challenging.
拉莫三嗪（LTG）用于治疗情绪障碍，但它与初始给药阶段皮疹发生的风险相关。虽然缓慢滴定可以降低这种风险，但它在治疗情绪障碍方面的有效性尚未得到验证。本研究旨在探讨滴定方法对 LTG 治疗情绪障碍的安全性和有效性的影响。
本回顾性队列研究纳入了 312 例接受 LTG 治疗的情绪障碍患者。收集了基线人口统计学数据、滴定方案、伴随用药以及 LTG 停药的时间和原因。采用多变量分析评估滴定方案的影响。还评估了 12 个月的疗效。
LTG 的 12 个月停药率为 16.7%。最常见的停药原因为皮疹（47.7%，n=312）。快速滴定（调整后比值比，8.15）显著增加了皮疹发生的风险，而缓慢滴定（调整后比值比，0.29）显著降低了这种风险。缓慢和标准滴定组之间的全因停药时间无显著差异（n=303）。治疗 12 个月后，使用 CGI-C，46.7%患者的病情被评为明显或非常明显改善。
尽管 LTG 的缓慢滴定可降低皮疹的发生，但长期来看并不比标准滴定更有效。优化情绪障碍患者的 LTG 初始滴定方案具有挑战性。
