The Effect of Race-Ethnicity on the Comparative Effectiveness of Clozapine Among Medicaid Beneficiaries
The Effect of Race-Ethnicity on the Comparative Effectiveness of Clozapine Among Medicaid Beneficiaries
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DOI：
10.1176/appi.ps.201200041
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发表时间：
2013-03-01
影响因子：
3.8
通讯作者：
Normand, Sharon-Lise T.
中科院分区：
文献类型：
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作者：
Horvitz-Lennon, Marcela;Donohue, Julie M.;Normand, Sharon-Lise T.
目的：有效性试验已经证实了氯氮平在精神分裂症治疗中的优越性，但对于这种药物的优越性是否在种族群体中存在却知之甚少。本研究通过种族-民族分析，比较了氯氮平相对于其他抗精神病药物在成人抗精神病药物维持治疗中的有效性。研究方法：黑人，拉丁美洲人，和白色佛罗里达医疗补助受益人与精神分裂症接受维持治疗与氯氮平或其他抗精神病药物之间的2000年7月1日，2005年6月30日，被确定。使用考克斯比例风险回归模型来估计氯氮平和种族-民族之间的关联及其相互作用;因任何原因停药的时间是有效性的主要衡量标准。结果如下：研究队列的20，122名成员占20，122次抗精神病药物治疗事件; 3.7%接受氯氮平治疗，96.3%接受其他抗精神病药物治疗。黑人占23%，拉丁裔占36%。未经调整的分析表明，拉丁美洲人继续服用氯氮平的时间比白人长，拉丁美洲人和黑人比白人更早停止服用其他抗精神病药物。对749名倾向评分匹配的氯氮平使用者和其他抗精神病药物使用者进行的调整分析表明，氯氮平使用者停药的风险较低（风险比[RR]= 0.45，95%置信区间[CI] = 0.39 - 0.52），这种效应不受种族的调节。氯氮平使用者的停药时间较长。黑人（RR=1.56，CI=1.27-1.91）和拉丁美洲人（RR=1.23，CI=1.02-1.48）的抗精神病药物停药的总体风险较高。结论：该研究证实了氯氮平的上级有效性，并没有发现种族改变这种效果的证据。研究结果强调，需要努力增加氯氮平的使用，特别是在少数群体中。
Objective: Effectiveness trials have confirmed the superiority of clozapine in schizophrenia treatment, but little is known about whether the drug's superiority holds across racial-ethnic groups. This study examined the effectiveness by race-ethnicity of clozapine relative to other antipsychotics among adult patients in maintenance antipsychotic treatment. Methods: Black, Latino, and white Florida Medicaid beneficiaries with schizophrenia receiving maintenance treatment with clozapine or other antipsychotics between July 1, 2000, and June 30, 2005, were identified. Cox proportional hazard regression models were used to estimate associations between clozapine and race-ethnicity and their interaction; time to discontinuation for any cause was the primary measure of effectiveness. Results: The 20,122 members of the study cohort accounted for 20,122 antipsychotic treatment episodes; 3.7% were treated with clozapine and 96.3% with other antipsychotics. Blacks accounted for 23% of episodes and Latinos for 36%. Unadjusted analyses suggested that Latinos continued on clozapine longer than whites and that Latinos and blacks discontinued other antipsychotics sooner than whites. Adjusted analyses of 749 propensity score-matched sets of clozapine users and other antipsychotic users indicated that risk of discontinuation was lower for clozapine users (risk ratio [RR]=.45, 95% confidence interval [CI] =.39-.52), an effect that was not moderated by race-ethnicity. Times to discontinuation were longer for clozapine users. Overall risk of antipsychotic discontinuation was higher for blacks (RR=1.56, CI=1.27-1.91) and Latinos (RR=1.23, CI=1.02-1.48). Conclusions: The study confirmed clozapine's superior effectiveness and did not find evidence that race-ethnicity modified this effect. The findings highlight the need for efforts to increase clozapine use, particularly among minority groups.