Miller D D, Fleming F, Holman T L, Perry P J
Mental Health Clinical Research Center, University of Iowa Hospital and Clinic 52242.
J Clin Psychiatry. 1994 Sep;55 Suppl B:117-21.
We investigated the relationship between plasma clozapine concentrations and clinical response in treatment-refractory schizophrenic patients. In a previous study, we found that plasma drug concentrations above 350 ng/mL maximized clinical response in a group of 29 patients. This study represents a follow-up of these original 29 patients over approximately 2 1/2 years of clozapine treatment. We found that during the initial 6-week trial of clozapine, 38% (N = 11) of the patients were considered to be responders. With continued treatment, we found that 58% (14 of 24) were classified as responders. Consistent with our previous study, we observed that plasma concentrations were helpful in predicting response. Five of 7 patients who had unsatisfactory response became responders when their plasma clozapine concentrations increased to above 350 ng/mL. We conclude that the assessment of plasma clozapine concentrations as a guide to dose adjustment may be useful in maximizing response.
我们研究了难治性精神分裂症患者血浆氯氮平浓度与临床反应之间的关系。在之前的一项研究中，我们发现，在一组29名患者中，血浆药物浓度高于350 ng/mL时临床反应最佳。本研究是对这最初的29名患者进行氯氮平治疗约2年半的随访。我们发现，在氯氮平治疗的最初6周试验期间，38%（N = 11）的患者被认为是有反应者。随着治疗的持续进行，我们发现58%（24名中的14名）被归类为有反应者。与我们之前的研究一致，我们观察到血浆浓度有助于预测反应。7名反应不佳的患者中有5名在血浆氯氮平浓度升至350 ng/mL以上时成为有反应者。我们得出结论，将血浆氯氮平浓度评估作为剂量调整的指导，可能有助于使反应最大化。
