Predictors of Nonhospitalization and Functional Response in Clozapine Treatment: A Nationwide, Population-Based Cohort Study
Predictors of Nonhospitalization and Functional Response in Clozapine Treatment: A Nationwide, Population-Based Cohort Study
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DOI：
10.1097/jcp.0000000000000649
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发表时间：
2017-04-01
影响因子：
2.9
通讯作者：
Gasse, Christiane
中科院分区：
文献类型：
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作者：
Kohler-Forsberg, Ole;Horsdal, Henriette T.;Gasse, Christiane
背景：氯氮平是难治性精神分裂症唯一的循证治疗方法，预测氯氮平的疗效对制定分层治疗方案具有重要意义。我们研究了潜在的预测因素，氯氮平的反应，应用功能评估以及service use.Procedures我们进行了一项全国性的队列研究，所有个人诊断为精神分裂症在丹麦1995年后（年龄，18岁）谁开始氯氮平治疗2004年和2011年之间的全球功能评估（GAF-F）分数注册在氯氮平开始。在长达2年的随访期间，临床应答定义为（a）未因精神分裂症进一步住院或（B）GAF-F评分改善（中度改善：增加，10;实质性改善：增加，20;和GAF-F，50）。我们进行了考克斯回归分析和报告调整后的风险率比（HRRs; 95%置信区间[95%CI]）。结果在502名注册GAF-F评分的氯氮平使用者中，232名（46.2%）仍然出院，96名（19.1%）实现中度功能改善，29名（5.8%）功能显著改善。在所有潜在的预测因素中，氯氮平开始时的自愿状态与未住院治疗显示出边缘统计学意义（HRR，1.61; 95%CI，0.97-2.67）。在功能改善方面，与伴侣生活在一起是最强的预测因素，HRR几乎增加了3倍（2.78; 95% CI，1.07-7.23）。女性性别是唯一的nonsignificantly与功能的改善，而大幅改善的机会下降了15%（HRR，0.85; 95%CI，0.72-1.00），每年延迟氯氮平开始在femines.Conclusions生活与合作伙伴是最强的预测功能后，氯氮平开始在这项研究中。虽然可能表明更好的病前功能，这一发现强调了社会支持的需要和重要性，在独立的临床因素的治疗过程中。
Background Clozapine remains the only evidence-based treatment for treatment-resistant schizophrenia, and prediction of clozapine response is important in developing stratified treatment. We studied potential predictors of clozapine response, applying functional assessments as well as service use.Procedures We performed a nationwide cohort study among all individuals diagnosed with schizophrenia in Denmark after 1995 (age, 18 years) who initiated clozapine treatment between 2004 and 2011 with a Global Assessment of Functioning (GAF-F) score registered at clozapine initiation. During up to 2-year follow-up, clinical response was defined as (a) no further hospitalization with schizophrenia or (b) improvement in GAF-F score (moderate improvement: increase, 10; substantial improvement: increase, 20; and GAF-F, 50). We performed Cox regression analysis and report adjusted hazard rate ratios (HRRs; 95% confidence intervals [95% CIs]).Results Among 502 clozapine users with a registered GAF-F score, 232 (46.2%) remained out of hospital, 96 (19.1%) achieved moderate functional improvement, and 29 (5.8%) substantial functional improvement. Of all potential predictors, voluntary status at clozapine initiation showed borderline statistical significance with nonhospitalization (HRR, 1.61; 95% CI, 0.97-2.67). Regarding functional improvement, living with a partner was the strongest predictor with an almost threefold increased HRR (2.78; 95% CI, 1.07-7.23). Female sex was only nonsignificantly associated with functional improvement, whereas the chance of substantial improvement decreased by 15% (HRR, 0.85; 95% CI, 0.72-1.00) for each year delay in clozapine initiation among females.Conclusions Living with a partner was the strongest predictor of functioning after clozapine initiation in this study. Although potentially indicating better premorbid functioning, this finding stresses the need and importance of social support during the course of the treatment independent of clinical factors.