Association between discontinuation due to withdrawal of consent and use of long-acting injectable antipsychotics: A meta-analysis of randomized trials for schizophrenia
Association between discontinuation due to withdrawal of consent and use of long-acting injectable antipsychotics: A meta-analysis of randomized trials for schizophrenia
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因撤回同意而停药与使用长效注射抗精神病药之间的关联：精神分裂症随机试验的荟萃分析
DOI：
10.1016/j.jpsychires.2020.10.009
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Iwata N.
中科院分区：
文献类型：
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作者：
Kishi T;Sakuma K;Okuya M;Iwata N.
我们调查了精神分裂症试验中因撤回同意而停药(DWC)与长效注射抗精神病药物(LAI-AP)的使用之间的关联。在随机对照试验的两个分类荟萃分析中，我们比较了DWC：单独和汇集的LAI-AP与(1)安慰剂和(2)口服抗精神病药物(OAP)。我们还进行了单组Meta分析以计算平均DWC，并进行Meta回归分析以检查Meta分析结果与与研究设计、治疗和患者相关的因素之间的关联。我们确定了52项研究(成年患者总数=118675，LAI-APs=112613，安慰剂=22083，OAPs=23979；研究持续时间的中位数=632周)。赖阿立哌唑的DWC高于安慰剂组[风险比(95%可信区间)t=1.70(1.23-2.39)]。混合或单独的LAI-AP与安慰剂氟奋乃静、奥氮平、帕利培酮和利培酮或阿立哌唑、氟奋乃静、氟哌啶醇、奥氮平、帕利培酮、利培酮和卓诺替索的OAP均无差异。每种LAI-AP的平均DWC分别为：来阿立哌唑=610.98%，来氟奋乃静=97.65%，来氟苯硫醇=93.33%，来氟哌啶醇D=66.71%，来奥氮平W=610.50%，来帕利酮Y=610.38%，来奋乃静Y=77.06%，来利培酮D=910.39%，来氟苯硫醇D=0.4.45%，混配L-氟哌啶醇F=99.88%，安慰剂=11.17%。Meta回归分析显示，出版年限(β=10.02)、男性百分比(β=10.02)和平均年龄(β=10.05)与合并LAI-AP的平均DWC值相关。研究持续时间(β=−=0.03)、男性百分比(β=0.08)和患者状态(β=−=0.85)与来阿立哌唑的平均DWC相关。安慰剂组的存在(β=91.60)与来氟奋乃静的平均DWC相关。LAI-AP的使用不太可能与DWC相关。虽然来阿立哌唑的DWC高于安慰剂，但其平均DWC与其他LAI-AP相似。
We investigated the association between discontinuation due to withdrawal of consent (DWC) in schizophrenia trials and the use of long-acting injectable antipsychotics (LAI-APs). In two categorical meta-analyses of randomized controlled trials, we compared DWC: individual and pooled LAI-APs vs. (1) placebo and (2) oral antipsychotics (OAPs). We also performed conducted a single-group meta-analysis to calculate the average DWC and a meta-regression analysis to examine the association between the results of the meta-analyses and factors related to study design, treatment, and patients. We identified 52 studies (total adult patients = 18,675, LAI-APs = 12,613, placebo = 2,083, and OAPs = 3,979; median study duration = 32 weeks). DWC was higher for LAI-aripiprazole than for the placebo [risk ratio (95% confidence interval) = 1.70 (1.23–2.39)]. Neither pooled nor individual LAI-APs differed from the placebo for fluphenazine, olanzapine, paliperidone, and risperidone or from the OAPs for aripiprazole, fluphenazine, haloperidol, olanzapine, paliperidone, risperidone, and zuclopenthixol. The average DWC of each LAI-AP was as follows: LAI-aripiprazole = 10.98%, LAI-fluphenazine = 7.65%, LAI-flupenthixol = 3.33%, LAI-haloperidol = 6.71%, LAI-olanzapine = 10.50%, LAI-paliperidone = 10.38%, LAI-perphenazine = 7.06%, LAI-risperidone = 10.39%, LAI-zuclopenthixol = 4.45%, pooled LAI-APs = 9.88%, and placebo = 11.17%. Meta-regression analysis demonstrated that publication year (β = 0.02), percentage of males (β = 0.02), and mean age (β = 0.05) were associated with an average DWC for pooled LAI-APs. Study duration (β = −0.03), percentage of males (β = 0.08), and patient status (β = −0.85) were associated with an average DWC for LAI-aripiprazole. Presence of a placebo arm (β = 1.60) was associated with an average DWC for LAI-fluphenazine. LAI-AP use was unlikely to be associated with DWC. Although the LAI-aripiprazole had a higher DWC than did the placebo, its average DWC was similar to other those of LAI-APs.