Laboratório Interdisciplinar de Neurociências Clínicas, Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Programa de Esquizofrenia, Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil.
Centre for Addiction and Mental Health, Toronto, ON, Canada. Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Braz J Psychiatry. 2023 Sep-Oct;45(5):448-458. doi: 10.47626/1516-4446-2023-3126. Epub 2023 Sep 17.
To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis.
The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%.
Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention.
通过系统评价和荟萃分析确定治疗抵抗性精神分裂症（TRS）的患病率及其相关因素。
根据系统评价和荟萃分析报告的首选项目（PRISMA）标准，于 2022 年 5 月 17 日在 PubMed 和 Embase 中进行了电子检索。所有评估了至少 20 例精神分裂症谱系患者并提供了 TRS 患病率数据或允许计算其患病率的数据的研究设计均包括在内。使用随机效应模型荟萃分析产生估计值。
在 50 项研究（n = 29,390）中，TRS 的患病率为 36.7%（95%CI 33.1-40.5，p < 0.0001）。患病率范围从首发患者的 22%（95%CI 18.4-25.8）到多次发作患者的 39.5%（95%CI 32.2-47.0）（Q = 18.27，p < 0.0001）。首次发作无反应定义的原发性治疗抵抗率为 23.6%（95%CI 20.5-26.8），而发病后/继发性（首次治疗反应后≥6 个月）的抵抗率为 9.3%（95%CI 6.8-12.2）。较长的病程和从长期住院或氯氮平诊所招募与更高的患病率估计值相关。在荟萃回归分析中，年龄较大和功能较差预测 TRS 更大。当仅包括偏倚风险较低的研究时，TRS 的患病率为 28.4%。
不同的研究设计和招募策略导致了 TRS 患病率的大部分观察到的异质性。结果表明，早期和晚期 TRS 是两种需要临床关注的独立疾病途径。
