Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
JAMA Netw Open. 2024 Oct 1;7(10):e2438358. doi: 10.1001/jamanetworkopen.2024.38358.
Antipsychotics are the cornerstone of maintenance treatment in schizophrenia spectrum disorders, but it is unclear which agents should be prioritized by prescribers.
To investigate the clinical effectiveness of antipsychotics, including recent market entries, in comparison with oral olanzapine in relapse and treatment failure prevention among individuals with schizophrenia spectrum disorder.
DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness research study with a within-individual analysis included data from Swedish health care registers of inpatient and specialized outpatient care, sickness absence, and disability pensions among all individuals aged 16 to 65 years who were diagnosed with schizophrenia spectrum disorder from January 1, 2006, to December 31, 2021, including an incident cohort and a prevalent cohort.
Specific antipsychotics.
The risks for psychosis relapse hospitalization and treatment failure (psychiatric hospitalization, death, or change in an antipsychotic medication) were adjusted for the temporal order of treatments, time since cohort entry, and concomitant drugs. Comparisons of all antipsychotics with oral olanzapine, the most commonly used antipsychotic, were investigated.
Among the full cohort of 131 476 individuals, the mean (SD) age of the study cohort was 45.7 (16.2) years (70 054 men [53.3%]). During a median follow-up of 12.0 years [IQR, 5.2-16.0 years], 48.5% of patients (N = 63 730) experienced relapse and 71.1% (N = 93 464) underwent treatment failure at least once. Compared with oral olanzapine, paliperidone 3-month long-acting injectable (LAI) was associated with the lowest adjusted hazard ratio (AHR) in the prevention of relapses (AHR, 0.66; 95% CI, 0.51-0.86), followed by aripiprazole LAI (AHR, 0.77 [95% CI, 0.70-0.84]), olanzapine LAI (AHR, 0.79 [95% CI, 0.73-0.86]), and clozapine (AHR, 0.82 [95% CI, 0.79-0.86]). Quetiapine was associated with the highest risk of relapse (AHR, 1.44 [95% CI, 1.38-1.51]). For prevention of treatment failure, paliperidone 3-month LAI was associated with the lowest AHR (AHR, 0.36 [95% CI, 0.31-0.42]), followed by aripiprazole LAI (AHR, 0.60 [95% CI, 0.57-0.63]), olanzapine LAI (AHR, 0.67 [95% CI, 0.63-0.72]), and paliperidone 1-month LAI (AHR, 0.71 [95% CI, 0.68-0.74]).
This comparative effectiveness research study demonstrated large differences in the risk of relapse and treatment failure among specific antipsychotic treatments. The findings contradict the widely held conception that all antipsychotics are equally effective in relapse prevention.
抗精神病药是精神分裂症谱系障碍维持治疗的基石，但目前尚不清楚哪些药物应优先考虑开给患者。
研究抗精神病药（包括最近上市的药物）在预防精神分裂症谱系障碍患者复发和治疗失败方面的临床效果，与口服奥氮平进行比较。
设计、地点和参与者：这是一项在个体内进行比较的有效性研究，纳入了来自瑞典医疗保健登记处的住院和专门门诊治疗、病假和残疾养老金的所有 16 至 65 岁的个体数据，这些个体在 2006 年 1 月 1 日至 2021 年 12 月 31 日期间被诊断为精神分裂症谱系障碍，包括一个发病队列和一个流行队列。
特定的抗精神病药物。
精神病复发住院和治疗失败（精神病住院、死亡或抗精神病药物更换）的风险，根据治疗的时间顺序、队列进入时间和伴随药物进行了调整。研究了所有抗精神病药与最常用的抗精神病药口服奥氮平的比较。
在 131476 名患者的全队列中，研究队列的平均（SD）年龄为 45.7（16.2）岁（70054 名男性[53.3%]）。在中位数为 12.0 年（IQR，5.2-16.0 年）的中位随访期间，48.5%的患者（n=63730）经历了复发，71.1%的患者（n=93464）至少经历了一次治疗失败。与口服奥氮平相比，帕利哌酮 3 个月长效注射剂（LAI）在预防复发方面的调整后危险比（AHR）最低（AHR，0.66；95%CI，0.51-0.86），其次是阿立哌唑 LAI（AHR，0.77 [95%CI，0.70-0.84]）、奥氮平 LAI（AHR，0.79 [95%CI，0.73-0.86]）和氯氮平（AHR，0.82 [95%CI，0.79-0.86]）。喹硫平与复发风险最高相关（AHR，1.44 [95%CI，1.38-1.51]）。在预防治疗失败方面，帕利哌酮 3 个月 LAI 与最低的 AHR 相关（AHR，0.36 [95%CI，0.31-0.42]），其次是阿立哌唑 LAI（AHR，0.60 [95%CI，0.57-0.63]）、奥氮平 LAI（AHR，0.67 [95%CI，0.63-0.72]）和帕利哌酮 1 个月 LAI（AHR，0.71 [95%CI，0.68-0.74]）。
这项比较有效性研究表明，特定抗精神病药物治疗在复发和治疗失败风险方面存在很大差异。研究结果与广泛认为所有抗精神病药在预防复发方面同样有效的观念相矛盾。
