Fabrazzo Michele, Cipolla Salvatore, Camerlengo Alessio, Perris Francesco, Catapano Francesco
Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie 1, 80138 Naples, Italy.
J Clin Med. 2022 Aug 3;11(15):4530. doi: 10.3390/jcm11154530.
Despite methodological limitations, real-world studies might support clinicians by broadening the knowledge of antipsychotics' (APs) effectiveness and tolerability in different clinical scenarios and complement clinical trials. We conducted an extensive literature search in the PubMed database to evaluate the effectiveness and tolerability profiles of second-generation antipsychotics (SGAs) from real-world studies to aid clinicians and researchers in selecting the proper treatment for patients with schizophrenia and related disorders. The present review evidenced that SGAs demonstrated superior effectiveness over first-generation antipsychotics (FGAs) in relapse-free survival and psychiatric hospitalization rate and for treating negative symptoms. Persistence and adherence to therapy were higher in SGAs than FGAs. Most studies concluded that switching to long-acting injectables (LAIs) was significantly associated with a lower treatment failure rate than monotherapy with oral SGAs. Considerable improvements in general functionality, subjective well-being, and total score on global satisfaction tests, besides improved personal and social performance, were reported in some studies on patients treated with LAI SGAs. Clozapine was also associated with the lowest rates of treatment failure and greater effectiveness over the other SGAs, although with more severe side effects. Effectiveness on primary negative symptoms and cognitive deficits was rarely measured in these studies. Based on the data analyzed in the present review, new treatments are needed with better tolerability and improved effectiveness for negative, affective, and cognitive symptoms.
尽管存在方法学上的局限性，但真实世界研究可能通过拓宽抗精神病药物（APs）在不同临床场景中的有效性和耐受性知识来支持临床医生，并补充临床试验。我们在PubMed数据库中进行了广泛的文献检索，以评估来自真实世界研究的第二代抗精神病药物（SGAs）的有效性和耐受性概况，以帮助临床医生和研究人员为精神分裂症及相关疾病患者选择合适的治疗方法。本综述表明，在无复发生存期、精神科住院率以及治疗阴性症状方面，SGAs比第一代抗精神病药物（FGAs）表现出更高的有效性。SGAs的治疗持续性和依从性高于FGAs。大多数研究得出结论，与口服SGAs单药治疗相比，改用长效注射剂（LAIs）与更低的治疗失败率显著相关。一些关于接受LAI SGAs治疗患者的研究报告称，除了个人和社会功能改善外，总体功能、主观幸福感以及总体满意度测试总分也有显著提高。氯氮平的治疗失败率也是最低的，并且比其他SGAs更有效，但副作用更严重。这些研究很少测量对原发性阴性症状和认知缺陷的有效性。基于本综述分析的数据，需要有更好耐受性且对阴性、情感和认知症状有效性更高的新治疗方法。
