Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston (Sanyal, Aparasu, Abughosh, Chen); Department of Child and Adolescent Psychiatry, Baylor College of Medicine, and Texas Children's Hospital, Houston (Calarge); Division of Management, Policy, and Community Health, University of Texas School of Public Health, Houston (Rowan); Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston (Sisley).
Psychiatr Serv. 2024 Apr 1;75(4):342-348. doi: 10.1176/appi.ps.20220584. Epub 2023 Oct 4.
Clinical guidelines recommend periodic monitoring for adverse metabolic effects associated with second-generation antipsychotic medications. The authors sought to evaluate adherence to the guideline-recommended metabolic monitoring schedule for children and adolescents prescribed second-generation antipsychotics.
The authors used a national electronic medical records database for a retrospective study of children and adolescents ages 1-17 years (N=9,620) who were prescribed second-generation antipsychotics in January 2010-December 2018. Adherence to guideline-recommended monitoring of body mass index (BMI), blood glucose, and cholesterol was categorized as full, partial, and no monitoring. Full monitoring of patients was defined as strict metabolic monitoring, following the guideline-recommended schedule. Patients who received any monitoring, but not meeting the full monitoring criteria, were considered partially monitored. Three multinomial logistic regression models were fitted for each metabolic parameter to identify predictors associated with monitoring status.
BMI was the metabolic parameter with the highest adherence to guideline-recommended monitoring (full monitoring, 4.7% of patients; partial monitoring, 44.8%), followed by blood glucose (full monitoring, 6.5%; partial monitoring, 29.4%) and cholesterol (full monitoring, 0.8%; partial monitoring, 22.4%). Being Black (vs. non-Black), having a comorbid mood disorder (vs. none), receiving olanzapine as the index second-generation antipsychotic (vs. aripiprazole), and receiving an antidepressant as a concurrent medication (vs. none) were associated with a higher likelihood of receiving both full and partial monitoring of all three metabolic parameters.
Both full and partial adherence to guideline-recommended monitoring of children and adolescents prescribed second-generation antipsychotics were poor. However, children and adolescents at increased metabolic risk tended to be more closely monitored.
临床指南建议定期监测与第二代抗精神病药物相关的不良代谢效应。作者旨在评估为服用第二代抗精神病药物的儿童和青少年规定的代谢监测时间表对指南建议的依从性。
作者使用国家电子病历数据库对 2010 年 1 月至 2018 年 12 月期间被处方第二代抗精神病药物的 1-17 岁儿童和青少年进行了回顾性研究（N=9620）。通过 BMI、血糖和胆固醇的完全、部分和无监测对依从性进行分类。患者的完全监测被定义为严格按照指南推荐的时间表进行代谢监测。接受任何监测但不符合完全监测标准的患者被认为是部分监测。对每个代谢参数拟合了三个多项逻辑回归模型，以确定与监测状态相关的预测因素。
BMI 是代谢参数中对指南建议的监测依从性最高的（完全监测，4.7%的患者；部分监测，44.8%），其次是血糖（完全监测，6.5%；部分监测，29.4%）和胆固醇（完全监测，0.8%；部分监测，22.4%）。与非黑人相比，黑人（vs.非黑人）、伴发心境障碍（vs.无）、奥氮平作为一线第二代抗精神病药物（vs.阿立哌唑）和同时服用抗抑郁药（vs.无）与三种代谢参数的完全和部分监测的可能性更高相关。
为服用第二代抗精神病药物的儿童和青少年规定的指南建议的完全和部分监测的依从性均较差。然而，代谢风险增加的儿童和青少年更倾向于接受密切监测。
