Okada Yusuke, Inada Ken, Akazawa Manabu
Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan.
Department of Psychiatry, Kitasato University School of Medicine, Kanagawa, Japan.
Schizophr Res. 2023 Feb;252:300-308. doi: 10.1016/j.schres.2023.01.019. Epub 2023 Jan 25.
To compare the effectiveness of different long-acting injectable antipsychotics (LAIs) (aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol) in patients with schizophrenia in Japan.
We conducted a retrospective cohort study using two administrative claims databases. The study population consisted of outpatients with schizophrenia who initiated LAIs between May 1, 2015, and November 30, 2019. We directly compared the risk of psychiatric hospitalization and LAI discontinuation among the LAIs based on hazard ratios (HRs) using Cox proportional hazards regression models.
The numbers of eligible patients who initiated aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol were 303, 124, 73, and 123, respectively. Regarding psychiatric hospitalization, aripiprazole and paliperidone were associated with significantly lower risk compared to fluphenazine/haloperidol (HR of aripiprazole: 0.47, 95 % CI: 0.28-0.78, HR of paliperidone: 0.50, 95 % CI: 0.28-0.89); HR of risperidone showed the same trend as the aripiprazole and paliperidone. Regarding LAI discontinuation, aripiprazole and paliperidone were associated with significantly lower risk of LAI discontinuation compared to fluphenazine/haloperidol (HR of aripiprazole: 0.53, 95 % CI: 95 % CI: 0.35-0.80, HR of paliperidone: 0.57, 95 % CI: 0.35-0.92). Aripiprazole was also associated with a significantly lower risk compared to risperidone (HR: 0.56, 95 % CI: 0.32-0.98).
Our study suggests that aripiprazole and paliperidone are superior to fluphenazine/haloperidol in the risk of psychiatric hospitalization and LAI discontinuation. Aripiprazole is superior to risperidone in the risk of LAI discontinuation.
比较不同长效注射用抗精神病药物（LAIs）（阿立哌唑、帕利哌酮、利培酮和氟奋乃静/氟哌啶醇）在日本精神分裂症患者中的疗效。
我们使用两个行政索赔数据库进行了一项回顾性队列研究。研究人群包括2015年5月1日至2019年11月30日期间开始使用LAIs的精神分裂症门诊患者。我们使用Cox比例风险回归模型，基于风险比（HRs）直接比较了不同LAIs之间精神科住院和LAIs停药的风险。
开始使用阿立哌唑、帕利哌酮、利培酮和氟奋乃静/氟哌啶醇的符合条件患者人数分别为303、124、73和123。关于精神科住院，与氟奋乃静/氟哌啶醇相比，阿立哌唑和帕利哌酮的风险显著更低（阿立哌唑的HR：0.47，95%CI：0.28 - 0.78，帕利哌酮的HR：0.50，95%CI：0.28 - 0.89）；利培酮的HR与阿立哌唑和帕利哌酮呈现相同趋势。关于LAIs停药，与氟奋乃静/氟哌啶醇相比，阿立哌唑和帕利哌酮的LAIs停药风险显著更低（阿立哌唑的HR：0.53，95%CI：0.35 - 0.80，帕利哌酮的HR：0.57，95%CI：0.35 - 0.92）。与利培酮相比，阿立哌唑的风险也显著更低（HR：0.56，95%CI：0.32 - 0.98）。
我们的研究表明，在精神科住院风险和LAIs停药方面，阿立哌唑和帕利哌酮优于氟奋乃静/氟哌啶醇。在LAIs停药风险方面，阿立哌唑优于利培酮。
