Tien Yun, Huang Hsiang-Ping, Liao Ding-Lieh, Huang Shang-Chien
Department of Psychiatry, Taoyuan Psychiatric Center, Taoyuan City, Taiwan (ROC).
Department of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Rd., Guishan Dist., Taoyuan City 33303, Taiwan (ROC).
Ther Adv Psychopharmacol. 2022 Jul 30;12:20451253221113238. doi: 10.1177/20451253221113238. eCollection 2022.
Aripiprazole is a third-generation antipsychotic agent with acceptable efficacy and a good safety profile. Previous studies have indicated the therapeutic serum concentration of aripiprazole to be 100 to 350 ng/ml; however, most of these studies examined a Western population. Patients with schizophrenia from Tungs' Taichung MetroHarbor Hospital in central Taiwan were recruited to analyze the dose-response relationship of aripiprazole in the Chinese population.
We aimed to investigate whether a serum concentration of aripiprazole higher than the current suggested range leads to higher response rates.
A prospective cohort study was designed to investigate the response rates in different studied cohorts grouped by serum concentration of aripiprazole.
Data of 64 patients who presented to a single medical center in central Taiwan and who received therapeutic drug monitoring (TDM) were obtained. Serum concentrations of aripiprazole were correlated with the clinical response of patients by using the Clinical Global Impressions (CGI) scores.
The mean concentration of aripiprazole was 432.1 ± 275.1 ng/ml in the study cohort. Among the much-improved patients, the mean serum concentration of aripiprazole was 494 ± 273 ng/ml (25th-75th percentiles 264-666 ng/ml), which was higher than the current recommended therapeutic target of 100-350 ng/ml for aripiprazole. The response rate in the severe group (baseline CGI score of 6 or 7) was significantly higher than in the moderate group (baseline CGI score of 4 or 5; 86.7% 55.9%, = 0.007).
A significantly higher response rate was observed in the study cohort with serum aripiprazole concentrations over 300 ng/ml. Therefore, dosing higher than the current recommended range may potentially improve the treatment efficacy in the Chinese population. Because the serum concentration varies among patients due to multiple intrinsic and extrinsic factors, TDM, especially in outpatients, is recommended if the clinical response is limited.
阿立哌唑是一种第三代抗精神病药物，疗效尚可且安全性良好。既往研究表明阿立哌唑的治疗血清浓度为100至350 ng/ml；然而，这些研究大多针对西方人群。招募了来自台湾中部董氏台中港滨医院的精神分裂症患者，以分析阿立哌唑在中国人群中的剂量反应关系。
我们旨在研究阿立哌唑血清浓度高于当前建议范围是否会导致更高的缓解率。
一项前瞻性队列研究旨在调查按阿立哌唑血清浓度分组的不同研究队列中的缓解率。
获取了64名到台湾中部一家医疗中心就诊并接受治疗药物监测（TDM）的患者的数据。通过使用临床总体印象（CGI）评分，将阿立哌唑的血清浓度与患者的临床反应相关联。
研究队列中阿立哌唑的平均浓度为432.1±275.1 ng/ml。在显著改善的患者中，阿立哌唑的平均血清浓度为494±273 ng/ml（第25至75百分位数为264 - 666 ng/ml），高于当前推荐的阿立哌唑治疗目标100 - 350 ng/ml。重度组（基线CGI评分为6或7）的缓解率显著高于中度组（基线CGI评分为4或5；86.7%对55.9%，P = 0.007）。
在阿立哌唑血清浓度超过300 ng/ml的研究队列中观察到显著更高的缓解率。因此，高于当前推荐范围给药可能会提高中国人群的治疗效果。由于血清浓度因多种内在和外在因素在患者之间存在差异，若临床反应有限，建议进行治疗药物监测，尤其是在门诊患者中。
