Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
Department of Community Psychiatry, Bali Psychiatric Center, MOHW, New Taipei City, Taiwan.
J Clin Psychiatry. 2022 Jun 1;83(4):21r14153. doi: 10.4088/JCP.21r14153.
Long-acting injectable antipsychotics (LAIs) may potentially benefit patients requiring psychiatric hospitalization during the early stages of schizophrenia. However, few studies have compared the long-term effectiveness between patients who switched to LAIs and those who remained on oral antipsychotics (OAPs). Using the Taiwan National Health Insurance Research Database, we constructed a population-based cohort with 19,813 new OAP users with defined schizophrenia who were hospitalized from 2002 to 2005. Within this cohort, 678 patients who switched to LAIs during their hospitalization were identified. The LAI group was matched to patients who remained on OAPs (n = 678). The LAI cohort was further subdivided for analysis into patients who switched to LAIs within 3 years of OAP initiation ("an early stage") and those who switched after 3 years ("a late stage"). Conditional Cox regressions and conditional negative binomial regressions were used to estimate the risk of death and the number of hospital visits between the two groups. During the 13-year study period, 312 patients switched to LAIs within the first 3 years of OAP initiation. All- and natural-cause mortalities in these patients were significantly lower than in those who remained on OAPs. The hazard ratios (HRs) for all- and natural-cause mortalities were 0.49 (95% confidence interval [CI], 0.27-0.87) and 0.30 (95% CI, 0.15-0.60), respectively. No significant decrease associated with LAIs was observed in unnatural-cause mortality. Patients receiving LAIs had lower risks of rehospitalization (incidence rate ratio [IRR] = 0.56, 95% CI, 0.45-0.69), psychiatric hospitalization (IRR = 0.63, 95% CI, 0.50-0.81), and psychiatric emergency room visits (IRR = 0.58, 95% CI, 0.45-0.75) compared to patients who remained on OAPs. Use of LAIs in the late stage of treatment did not decrease the risk of relapse or mortality. Switching to LAIs during the first 3 years of treatment improved antipsychotic adherence, decreased relapses, and reduced long-term mortality. Our results provide evidence to support the benefits of early LAI treatment in schizophrenia.
长效注射型抗精神病药物（LAIs）可能对精神分裂症早期需要住院治疗的患者有益。然而，很少有研究比较过转换为 LAI 治疗的患者与继续使用口服抗精神病药物（OAPs）的患者之间的长期疗效。我们利用台湾全民健康保险研究数据库，建立了一个基于人群的队列，纳入了 19813 名在 2002 年至 2005 年住院的有明确精神分裂症的新 OAP 使用者。在这个队列中，我们确定了 678 名在住院期间转换为 LAI 的患者。LAI 组与继续使用 OAP 的患者（n=678）进行匹配。进一步将 LAI 队列分为 OAP 起始后 3 年内转换为 LAI 的患者（“早期阶段”）和 3 年后转换为 LAI 的患者（“晚期阶段”）进行分析。使用条件 Cox 回归和条件负二项回归来估计两组之间的死亡风险和住院次数。在 13 年的研究期间，有 312 名患者在 OAP 起始后的前 3 年内转换为 LAI。这些患者的全因和自然死因死亡率明显低于继续使用 OAP 的患者。全因和自然死因的风险比（HRs）分别为 0.49（95%置信区间 [CI]，0.27-0.87）和 0.30（95% CI，0.15-0.60）。LAI 治疗与非自然原因死亡率的降低无关。使用 LAI 的患者再次住院（发病率比 [IRR] = 0.56，95%CI，0.45-0.69）、精神病住院（IRR = 0.63，95%CI，0.50-0.81）和精神病急诊就诊（IRR = 0.58，95%CI，0.45-0.75）的风险均低于继续使用 OAP 的患者。在治疗的晚期开始使用 LAI 并不能降低复发或死亡的风险。在治疗的前 3 年内转换为 LAI 可提高抗精神病药物的依从性，减少复发，并降低长期死亡率。我们的研究结果为支持精神分裂症早期 LAI 治疗的益处提供了证据。
