Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment
Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment
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DOI：
10.1176/appi.ajp.163.4.600
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发表时间：
2006-04-01
影响因子：
17.7
通讯作者：
Hsiao, JK
中科院分区：
文献类型：
--
作者：
McEvoy, JP;Lieberman, JA;Hsiao, JK
目的：当精神分裂症患者对抗精神病药物治疗反应不足时，尚不清楚应改用哪种其他抗精神病药物以及何时使用氯氮平。在这项研究中，作者比较了在干预有效性临床抗精神病药物试验（CATIE）调查的背景下，停止使用新型非典型抗精神病药物治疗的患者转换为氯氮平与转换为另一种非典型抗精神病药物。99名在1期或1B期试验中停用奥氮平、奎替鲁、利培酮或齐拉西酮治疗的患者，主要是因为疗效不足，被随机分配到开放标签治疗氯氮平（N=49）或盲法治疗的另一种新的非典型抗精神病药物，以前没有收到的试验（奥氮平[ N=19]、奎替鲁[ N=15]或利培酮[ N=16]）。氯氮平（中位数=10.5个月）至因任何原因停药的时间显著长于奎替鲁（中位数=3.3）或利培酮（中位数=2.8），但奥氮平（中位数=2.7）则不然。氯氮平组因治疗效果不佳而停药的时间显著长于奥氮平、奎替鲁或利培酮。在3个月的评估中，阳性和阴性症状量表总评分在接受氯氮平治疗的患者中的下降幅度大于接受奎替鲁胺或利培酮治疗的患者，但奥氮平没有。一个病人用氯氮平治疗粒细胞缺乏症，另一个开发嗜酸性粒细胞增多症，都需要治疗continuation.Conclusions：对于这些精神分裂症患者前瞻性未能改善与非典型抗精神病药物，氯氮平是更有效的比切换到另一个新的非典型抗精神病药物。安全性监测是必要的，以发现和管理氯氮平的严重副作用。
Objective: When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug, it is unclear what other antipsychotic to switch to and when to use clozapine. In this study, the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness ( CATIE) investigation.Method: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone in phase 1 or 1B of the trials, primarily because of inadequate efficacy, were randomly assigned to open-label treatment with clozapine ( N=49) or blinded treatment with another newer atypical antipsychotic not previously received in the trial ( olanzapine [ N=19], quetiapine [ N=15], or risperidone [ N=16]).Results: Time until treatment discontinuation for any reason was significantly longer for clozapine ( median=10.5 months) than for quetiapine ( median=3.3), or risperidone ( median=2.8), but not for olanzapine ( median=2.7). Time to discontinuation because of inadequate therapeutic effect was significantly longer for clozapine than for olanzapine, quetiapine, or risperidone. At 3-month assessments, Positive and Negative Syndrome Scale total scores had decreased more in patients treated with clozapine than in patients treated with quetiapine or risperidone but not olanzapine. One patient treated with clozapine developed agranulocytosis, and another developed eosinophilia; both required treatment discontinuation.Conclusions: For these patients with schizophrenia who prospectively failed to improve with an atypical antipsychotic, clozapine was more effective than switching to another newer atypical antipsychotic. Safety monitoring is necessary to detect and manage clozapine's serious side effects.