Medication Nonadherence and Treatment Outcome in Patients With Schizophrenia or Schizoaffective Disorder With Suboptimal Prior Response
Medication Nonadherence and Treatment Outcome in Patients With Schizophrenia or Schizoaffective Disorder With Suboptimal Prior Response
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DOI：
10.4088/jcp.08m04221
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发表时间：
2009-07-01
影响因子：
5.3
通讯作者：
Volavka, Jan
中科院分区：
文献类型：
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作者：
Lindenmayer, Jean-Pierre;Liu-Seifert, Hong;Volavka, Jan
目的：探讨药物不依从性对精神分裂症治疗结果的影响以及不依从性的潜在危险因素。方法：对一项随机、双盲、为期 8 周的固定剂量研究进行事后分析，比较奥氮平 10、20 和 40 mg/天治疗精神分裂症或分裂情感性障碍（DSM-IV 标准）对当前治疗反应欠佳的患者（N = 599）于2003年9月12日至2005年11月3日在美国的55个研究中心进行。不依从性被定义为不按照每日药丸计数规定服用药物。由于剂量组之间的不依从性没有显着差异，因此结合所有 3 组来检查不依从性对疗效和安全性结果的影响。将基线人口统计数据和症状严重程度作为不依从的潜在危险因素进行调查。结果：在为期 8 周的研究中，34.5% 的患者至少有一次不依从。通过阳性和阴性症状量表总分的变化来衡量，与依从性患者相比，非依从性患者的改善明显较差（-22.57 vs. -26.84，p = .002）。较长的不依从持续时间与治疗反应的可能性降低相关（比值比 = 0.94，95% CI = 0.90 至 0.99，p = 0.008）。与依从性患者相比，非依从性患者的早期治疗终止率较高（40.8% vs. 24.5%，p < .001）。依从性和非依从性患者在大多数安全措施中具有相似的结果，但体重变化除外，其中依从性患者比非依从性患者体重增加更大（2.63 kg vs. 1.96 kg，p = .02）。基线时抑郁严重程度较高 (p = .01) 和研究期间敌意程度较高是不依从性的显着风险因素 (p = .02)。结论：药物不依从性对治疗反应具有显着的负面影响，强调了依从性对于获得满意的治疗结果的重要性。研究结果还可以帮助临床医生识别存在不依从性风险的患者，并利用干预措施来提高依从性。
Objective: To examine the impact of medication nonadherence on treatment outcome in schizophrenia and potential risk factors for nonadherence.Method: A post hoc analysis of a randomized, double-blind, 8-week, fixed-dose study comparing olanzapine 10, 20, and 40 mg/day for patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) with suboptimal response to current treatment (N = 599) was conducted between September 12, 2003, and November 3, 2005, at 55 study centers in the United States. Nonadherence was defined as not taking medication as prescribed based on daily pill counts. Because there was no significant difference in nonadherence between dose groups, effects of nonadherence on efficacy and safety outcomes were examined using all 3 groups combined. Baseline demographics and symptom severity were investigated as potential risk factors for nonadherence.Results: During the 8-week study, 34.5% of patients were nonadherent at least once. Nonadherent patients had significantly less improvement compared to adherent patients as measured by change in Positive and Negative Syndrome Scale total score (-22.57 vs. -26.84, p = .002). Longer duration of nonadherence was associated with reduced likelihood of treatment response (odds ratio = 0.94, 95% CI = 0.90 to 0.99, p = .008). The early treatment discontinuation rate was higher in nonadherent compared to adherent patients (40.8% vs. 24.5%, p < .001). Adherent and nonadherent patients had comparable outcomes in most safety measures, except for weight change, for which adherent patients had greater weight gain than nonadherent patients (2.63 kg vs. 1.96 kg, p = .02). Greater depression severity at baseline (p = .01) and greater hostility level during the study were significant risk factors for nonadherence (p = .02).Conclusions: Medication nonadherence had a significantly negative impact on treatment response, highlighting the importance of adherence to achieve satisfactory treatment outcome. Findings may also help clinicians identify patients at risk for nonadherence and utilize interventions to improve adherence.