Henderson D C, Nasrallah R A, Goff D C
Erich Lindemann Mental Health Center and the Psychiatry Service, Massachusetts General Hospital, Boston, USA.
J Clin Psychiatry. 1998 Nov;59(11):585-8. doi: 10.4088/jcp.v59n1105.
In our experience, many of our schizophrenic patients treated with clozapine request the newer atypical antipsychotic agents in order to eliminate the weekly blood monitoring. However, there are few guidelines available to clinicians interested in switching patients successfully treated with clozapine to olanzapine.
The goal of this study was to collect preliminary data on the safety, clinical effectiveness, and predictors of response of switching clozapine patients to olanzapine. In an open trial, 19 patients receiving clozapine were switched to olanzapine.
Eight (42%) of 19 patients were considered responders. Seven patients decompensated seriously enough to require hospitalization. All 7 of these patients were restabilized on clozapine treatment in the hospital, and olanzapine was discontinued. In an additional 4 patients, clinical status worsened, and clozapine doses were titrated upwards and olanzapine was slowly discontinued. Overall, mean total Brief Psychiatric Rating Scale (BPRS) scores increased significantly from baseline to final assessment (p = .02). Responders had been treated for a significantly shorter period of time with clozapine prior to the switch compared to nonresponders (p = .04) and were receiving a lower dose of clozapine (p = .05). The final olanzapine dose did not differ between responders and nonresponders. All responders have remained on olanzapine treatment and are stable.
In this open trial, the crossover from clozapine to olanzapine was generally well tolerated and resulted in a successful transition for 8 of the 19 patients. However, mean scores on the total BPRS and negative symptom and depressive symptom subscales significantly increased. Caution must be taken in determining which patients may benefit from the switch to olanzapine because of the risk of decompensation and hospitalization. Because this was an open trial, these findings require replication in a controlled trial.
根据我们的经验，许多接受氯氮平治疗的精神分裂症患者要求换用更新的非典型抗精神病药物，以便免去每周的血液监测。然而，对于有意将成功接受氯氮平治疗的患者换用奥氮平的临床医生而言，几乎没有可用的指导原则。
本研究的目的是收集有关将氯氮平治疗的患者换用奥氮平的安全性、临床疗效及反应预测因素的初步数据。在一项开放性试验中，将19例接受氯氮平治疗的患者换用奥氮平。
19例患者中有8例（42%）被视为有反应者。7例患者病情严重恶化，需要住院治疗。所有这7例患者在医院重新接受氯氮平治疗后病情稳定，奥氮平停用。另外4例患者临床状况恶化，氯氮平剂量上调，奥氮平缓慢停用。总体而言，简明精神病评定量表（BPRS）总分从基线至最终评估显著增加（p = .02）。与无反应者相比，有反应者在换药前接受氯氮平治疗的时间显著更短（p = .04），且接受的氯氮平剂量更低（p = .05）。有反应者和无反应者的最终奥氮平剂量无差异。所有有反应者均继续接受奥氮平治疗且病情稳定。
在这项开放性试验中，从氯氮平换用奥氮平总体耐受性良好，19例患者中有8例成功过渡。然而，BPRS总分及阴性症状和抑郁症状分量表的平均分显著增加。由于存在病情恶化和住院的风险，在确定哪些患者可能从换用奥氮平中获益时必须谨慎。由于这是一项开放性试验，这些发现需要在对照试验中重复验证。
