Adhikari Keyuri, Kamal Khalid M, Jeun Ki Jin, Nolfi David A, Ashraf Mohammed Najeeb, Zacker Christopher
Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA.
Gumberg Library, Duquesne University, Pittsburgh, PA, USA.
Clinicoecon Outcomes Res. 2024 Sep 6;16:621-645. doi: 10.2147/CEOR.S469024. eCollection 2024.
Schizophrenia is a complex, chronic mental health disorder that confers a substantial disease burden globally. Oral antipsychotic treatments (OATs) are the mainstay for treating early and advanced stages of schizophrenia. Our systematic review aimed to synthesize literature describing real-world effectiveness, economic, and humanistic outcomes of OATs (asenapine, brexpiprazole, cariprazine, iloperidone, lumateperone, lurasidone, olanzapine/samidorphan, paliperidone, and quetiapine) for successful management of the disease.
PubMed, American Psychological Association PsycINFO (EBSCOhost), and Cumulative Index of Nursing and Allied Health Literature were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting real-world effectiveness, costs, humanistic, behavioral (eg, interpersonal relations, suicide ideation), medication adherence, and product-switching outcomes for selected OATs published in English from January 2010 to March 2022 were identified and evaluated qualitatively.
We included 48 studies with different designs providing extensive evidence on schizophrenia. All studies were conducted in countries outside of the United States. In most studies, antipsychotic medications were more effective than placebo, suggesting their value in the management of schizophrenia. Sixteen studies measured the economic outcomes of OATs. Eight studies assessed humanistic outcomes, while one reported behavioral outcomes in three second-generation antipsychotics. Medication adherence was described in two studies, while five studies evaluated product switching. Non-adherence was commonly reported for OATs. Medication non-adherence and treatment discontinuation were predominant factors contributing to the economic burden of schizophrenia.
Our research showcased a significant knowledge gap across OATs spanning the humanistic and behavioral outcomes and medication adherence and switching, suggesting a need for robust evidence generation to help clinicians and payers make informed decisions regarding treatment opportunities and cost-effective strategies for patients with schizophrenia.
精神分裂症是一种复杂的慢性心理健康障碍，在全球范围内造成了巨大的疾病负担。口服抗精神病药物治疗（OATs）是治疗精神分裂症早期和晚期的主要手段。我们的系统评价旨在综合描述OATs（阿立哌唑、布雷哌嗪、卡立普嗪、伊潘立酮、鲁马哌酮、卢沙西酮、奥氮平/沙美阿片、帕利哌酮和喹硫平）在成功管理该疾病方面的真实世界有效性、经济性和人文结局的文献。
根据系统评价和Meta分析的首选报告项目指南，检索了PubMed、美国心理学会PsycINFO（EBSCOhost）和护理及相关健康文献累积索引。确定并定性评估了2010年1月至2022年3月以英文发表的关于选定OATs的真实世界有效性、成本、人文、行为（如人际关系、自杀意念）、药物依从性和产品转换结局的研究。
我们纳入了48项设计不同的研究，这些研究为精神分裂症提供了广泛的证据。所有研究均在美国以外的国家进行。在大多数研究中，抗精神病药物比安慰剂更有效，表明它们在精神分裂症管理中的价值。16项研究测量了OATs的经济结局。8项研究评估了人文结局，而1项研究报告了三种第二代抗精神病药物的行为结局。两项研究描述了药物依从性，而五项研究评估了产品转换。OATs普遍存在不依从的情况。药物不依从和治疗中断是导致精神分裂症经济负担的主要因素。
我们的研究表明，在OATs的人文和行为结局、药物依从性和转换方面存在重大知识空白，这表明需要生成有力的证据，以帮助临床医生和支付方就精神分裂症患者的治疗机会和成本效益策略做出明智的决策。
