Treatment changes among older patients with dementia treated with antipsychotics.
Treatment changes among older patients with dementia treated with antipsychotics.
复制标题
DOI：
10.1002/gps.4281
复制
发表时间：
2015-12
影响因子：
4
通讯作者：
Kales H
中科院分区：
文献类型：
--
作者：
Kim HM;Chiang C;Weintraub D;Schneider LS;Kales H
处方实践模式和与老年患者开始抗精神病药物治疗痴呆的行为和心理症状的治疗变化相关的因素还不清楚。本研究的目的是研究三种最常见的抗精神病药物的90天处方实践模式。这是一项使用美国退伍军人事务部（VA）国家数据的回顾性研究。该研究包括2005年至2008年期间开始接受抗精神病药物门诊治疗的65岁以上痴呆症患者。患者从开始服用抗精神病药物后随访90天。主要关注事件为改用另一种精神药物。治疗变化的累积发生率以抗精神病药物停药和死亡作为竞争风险来确定。使用竞争风险回归模型确定治疗变化的协变量校正风险比。在研究期间，15，435例患者开始使用非典型抗精神病药物; 14，791例开始使用奥氮平、奎替利嗪或利培酮。超过一半（55%）的患者在90天内停止了索引治疗，36%继续，3%在索引治疗期间死亡，6%改为另一种精神药物。与奎替鲁相比，奥氮平和利培酮的调整后治疗变化风险分别高出43%（p = 0.005）和12%（p = 0.08）。奥氮平治疗变化的风险较高，表明与奎替鲁相比，奥氮平治疗患者的反应更差或发生的不良事件更多。
Prescribing practice patterns and factors associated with treatment changes in older patients initiating antipsychotic treatment for the behavioral and psychological symptoms of dementia is not well known. The objective of this study is to study 90-day prescribing practice patterns across the three most commonly prescribed antipsychotics. This is a retrospective study using national data from the US Department of Veterans Affairs (VA). The study included patients older than 65 years diagnosed with dementia who began outpatient treatment with an antipsychotic medication between 2005 and 2008. Patients were followed for 90 days from their antipsychotic start. The primary event of interest was changing to another psychotropic medication. Cumulative incidence of treatment change was determined with antipsychotic discontinuation and death as competing risks. Covariate-adjusted hazard ratios for treatment change were determined using competing risk regression models. During the study period, 15,435 patients initiated an atypical antipsychotic; 14,791 started olanzapine, quetiapine, or risperidone. Over half (55%) of the patients discontinued index treatment within 90 days, 36% continued, 3% died while on index treatment, and 6% changed to another psychotropic medication. Compared with quetiapine, the adjusted hazard of treatment change was higher by 43% (p = 0.005) for olanzapine and by 12% (p = 0.08) for risperidone. The higher hazard of treatment change with olanzapine suggests patients either responded worse to or experienced more adverse events with olanzapine compared with quetiapine.
登录
查看更多内容
影响因子：
105.7
作者：
Ballard, C;Margallo-Lana, M;Jacoby, R
通讯作者：
Jacoby, R
影响因子：
158.5
作者：
Devanand, D. P.;Mintzer, Jacobo;Levin, Bruce
通讯作者：
Levin, Bruce
影响因子：
17.7
作者：
Kales, Helen C.;Valenstein, Marcia;Blow, Frederic C.
通讯作者：
Blow, Frederic C.
影响因子：
10.6
作者：
Andreasen, Nancy C.;Pressler, Marcus;Nopoulos, Peg;Miller, Del;Ho, Beng-Choon
通讯作者：
Ho, Beng-Choon
DOI：
10.1097/01.jgp.0000200589.01396.6d
发表时间：
2006-03-01
影响因子：
7.2
作者：
Schneider, LS;Dagerman, K;Insel, PS
通讯作者：
Insel, PS