Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Abdya Campus, Prince Sultan Bin AbdulAziz Road, 24381, Makkah, Kingdom of Saudi Arabia.
School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham, B15 2TT, UK.
Int J Clin Pharm. 2023 Oct;45(5):1241-1251. doi: 10.1007/s11096-023-01642-5. Epub 2023 Sep 27.
Despite their known effectiveness, antipsychotics possess significant cardiometabolic adverse event profiles. Guidelines emphasise routine monitoring, however, practices are known to be suboptimal.
To investigate the level of cardiometabolic monitoring among people prescribed antipsychotic therapy in primary care, and patient-related factors that may influence monitoring patterns.
Data were collected for patients with mental disorders and prescribed antipsychotics at two general practices in England (February 2016-February 2021). The main outcome measures were the proportion of patients with evidence of monitoring for cardiometabolic parameters (body composition, anthropometrics, lipids, glucose outcomes). Regression analysis was used to explore factors predicting monitoring practices.
Data from 497 patients were included. The proportion of patients receiving cardiometabolic monitoring at least once yearly varied across different parameters. Patients were mostly monitored for BP (92.0%), body weight (BMI > 85.0%) and HDL (72.0%), but to a lesser extent for other lipid parameters (non-HDL < 2.0%) and blood glucose (< 2.0%). Ageing (OR:2.0-7.0, p < 0.001) and chronic conditions (e.g., CVD and Type 2 DM, p < 0.05) were associated with frequent cardiometabolic monitoring. Conversely, antipsychotics with high metabolic risks (olanzapine), patients prescribed antipsychotic polypharmacy (≥ 2 antipsychotics) and cardiometabolic dysregulations (e.g., dyslipidaemias) did not improve monitoring frequencies.
Cardiometabolic health monitoring was generally infrequent, irregular, and did not change in response to abnormal test results or antipsychotic treatment with high cardiometabolic risks, suggesting more efforts need to be made to ensure the guidelines for cardiometabolic monitoring are followed. Future studies should investigate practices by using a large UK primary care database.
尽管抗精神病药已被证实有效，但它们具有显著的代谢不良事件特征。指南强调了常规监测，但实践中这种监测并不理想。
调查初级保健中接受抗精神病药物治疗的患者进行代谢监测的水平，以及可能影响监测模式的患者相关因素。
在英格兰的两家普通诊所收集了患有精神障碍并开处抗精神病药物的患者的数据（2016 年 2 月至 2021 年 2 月）。主要结局指标是监测代谢参数（身体成分、人体测量学、血脂、血糖结果）的患者比例。回归分析用于探索预测监测实践的因素。
共纳入 497 名患者的数据。不同参数的患者接受代谢监测的比例各不相同。患者主要监测血压（92.0%）、体重（BMI＞85.0%）和高密度脂蛋白（72.0%），但其他血脂参数（非高密度脂蛋白＜2.0%）和血糖（＜2.0%）监测较少。年龄增长（OR：2.0-7.0，p＜0.001）和慢性病（如心血管疾病和 2 型糖尿病，p＜0.05）与频繁的代谢监测有关。相反，代谢风险较高的抗精神病药物（奥氮平）、同时服用多种抗精神病药物（≥2 种）和代谢紊乱（如血脂异常）的患者并未提高监测频率。
代谢健康监测总体上不频繁、不规律，且不会因异常检查结果或使用代谢风险较高的抗精神病药物治疗而改变，这表明需要进一步努力确保遵循代谢监测指南。未来的研究应该使用大型英国初级保健数据库来调查实践情况。
