Effectiveness of switching antipsychotic medications.
Effectiveness of switching antipsychotic medications.
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更换抗精神病药物的有效性。
DOI：
10.1176/ajp.2006.163.12.2090
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Lieberman,JeffreyA
中科院分区：
文献类型：
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作者：
Essock,SusanM;Covell,NancyH;Davis,SoniaM;Stroup,TScott;Rosenheck,RobertA;Lieberman,JeffreyA
目的尽管缺乏与药物改变相关的风险和益处的信息，但改变抗精神病药物很常见。作者检查了临床抗精神病药物干预效果试验 (CATIE) 研究的 1 期结果，以探讨继续服用基线时接受的药物或改用不同的抗精神病药物是否更有利。方法首先，对于随机分配接受奥氮平 (N=314) 或利培酮 (N=321) 治疗的患者，作者评估了被分配继续接受治疗的影响。 他们在进入研究时接受的药物与被分配从不同的抗精神病药物转换为这些药物的比较。其次，对于基线抗精神病药物为奥氮平 (N=319)、利培酮 (N=271) 或喹硫平 (N=94) 的患者，作者检查了随机分配使用相同抗精神病药物与更换药物的影响。最后，作者评估了删除 209 名患者数据的影响，这些患者的随机分配是继续使用基线抗精神病药物。作者遵循 CATIE 的分析策略；主要结局是直到全因治疗停止的时间。结果被随机分配到奥氮平和利培酮治疗并继续使用基线药物的个体比被分配到换用抗精神病药物的个体到停止治疗的时间明显更长。当这些“停留者”被移除时，原始 CATIE 第一阶段分析中看到的差异被减弱，尽管最初的结果模式仍然存在。 结论 药物有效性的比较应考虑被比较的药物是否都是新开始的。此外，除非临床情况需要改变药物治疗，否则处方者可能希望在更换药物之前采取措施优化当前的药物治疗方案（例如剂量调整、行为或社会心理干预）。
ObjectiveChanging antipsychotics is common despite the dearth of information on risks and benefits associated with medication changes. The authors examined phase 1 findings from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study to explore whether it was more advantageous to continue taking the medication being received at baseline or to switch to a different antipsychotic.MethodFirst, for patients randomly assigned to treatment with olanzapine (N=314) or risperidone (N=321), the authors assessed the impact of being assigned to stay with the medication they were receiving at entry into the study versus being assigned to switch to these medications from a different antipsychotic. Second, for patients whose baseline antipsychotic was olanzapine (N=319), risperidone (N=271), or quetiapine (N=94), the authors examined the impact of being randomly assigned to stay with the same antipsychotic versus switch. Finally, the authors assessed the impact of removing the data of 209 patients whose random assignment was to stay with their baseline antipsychotic. The authors followed analysis strategies for CATIE; primary outcome was time until all-cause treatment discontinuation.ResultsIndividuals randomly assigned to olanzapine and risperidone who were continuing with their baseline medication had significantly longer times until discontinuation than did those assigned to switch antipsychotics. When these “stayers” were removed, differences seen in the original CATIE phase 1 analyses were attenuated, although the original pattern of results remained.ConclusionsComparisons of medication effectiveness should take into account whether medications being compared were each newly initiated. Further, unless the clinical situation requires a medication change, prescribers may want to take steps to optimize current medication regimens (e.g., dosage adjustments, behavioral or psychosocial interventions) before switching medications.