Clinical, functional, and economic ramifications of early nonresponse to antipsychotics in the naturalistic treatment of schizophrenia.
Clinical, functional, and economic ramifications of early nonresponse to antipsychotics in the naturalistic treatment of schizophrenia.
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DOI：
10.1093/schbul/sbm134
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发表时间：
2008-11
影响因子：
6.6
通讯作者：
Shekhar, Anantha
中科院分区：
文献类型：
--
作者：
Ascher-Svanum, Haya;Nyhuis, Allen W.;Faries, Douglas E.;Kinon, Bruce J.;Baker, Robert W.;Shekhar, Anantha
目的：在以急性住院精神分裂症患者为主的随机对照试验中，早期对抗精神病药无应答似乎预示着随后的治疗无应答。本研究评估了早期治疗无应答的预测准确性及其在自然主义治疗主要为慢性门诊精神分裂症患者中的临床、功能和经济后果。研究方法：这项事后分析使用了一项为期1年、随机化、开放标签研究的数据，该研究评估了奥氮平、利培酮和典型抗精神病药物治疗精神分裂症的疗效。如果临床需要，患者可以在治疗8周后转换抗精神病药物。纳入了完成8周治疗的患者（n = 443/664例入组者）。将早期应答患者（2周时阳性和阴性症状量表较基线改善≥20%）与早期无应答者在症状缓解、功能、药物影响感知和8周时的总医疗保健费用方面进行比较。结果如下：2周时的早期应答/无应答可预测随后8周时的应答/无应答，准确性（72%）和特异性（89%）较高。8周后，早期无应答者不太可能达到症状缓解（P <0.001），功能领域改善较少（P <0.05），认为药物治疗的益处较少（P = 0.004），总医疗费用是早期应答者的两倍多（4349美元vs 2102美元，P = 0.010）。结论：在精神分裂症患者的常规治疗中，早期无应答似乎可以可靠地预测后续对相同药物的持续治疗无应答，与较差的结局和较高的医疗费用相关。识别早期无应答者可以最大限度地减少延长暴露于次优或无效的治疗策略。
Objective: Early nonresponse to antipsychotics appears to predict subsequent nonresponse to treatment when assessed in randomized controlled trials of predominately acute inpatients treated for schizophrenia. This study assessed the predictive accuracy of early nonresponse to treatment and its clinical, functional, and economic ramifications in the naturalistic treatment of predominately chronic outpatients treated for schizophrenia. Methods: This post hoc analysis used data from a 1-year, randomized, open-label study of olanzapine, risperidone, and typical antipsychotics in the treatment of schizophrenia. If clinically warranted, patients could switch antipsychotics following 8 weeks of treatment. Patients completing 8 weeks of treatment (n = 443 of 664 enrollees) were included. Patients with early response (≥20% improvement from baseline on the Positive and Negative Syndrome Scale at 2 weeks) were compared with early nonresponders on symptom remission, functionality, perceptions of medication influence, and total health care costs at 8 weeks. Results: Early response/nonresponse at 2 weeks predicted subsequent response/nonresponse at 8 weeks with a high level of accuracy (72%) and specificity (89%). After 8 weeks, early nonresponders were less likely to achieve symptom remission (P < .001), improved less on functional domains (P < .05), perceived medication as less beneficial (P = .004), and incurred total heath care costs over twice that of early responders ($4349 vs $2102, P = .010). Conclusions: In the usual care of schizophrenia patients, early nonresponse appears to reliably predict subsequent nonresponse to continued treatment with the same medication to be associated with poorer outcomes and higher health care costs. Identifying early nonresponders may minimize prolonging exposure to suboptimal or ineffective treatment strategies.
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影响因子：
1.1
作者：
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