2/2-A Comparison of Long-Acting Injectable Medications for Schizophrenia -ACLAIMS

项目总结 令人担忧的是，推动临床实践的是营销，而不是证据。昂贵的新产品的使用 药物的使用范围往往远远超出其既定的价值。最近独立的、客观的比较 口服抗精神病药物制剂对新药实现的市场饱和几乎没有提供支持 非典型的抗精神病药物。一种长效注射(LAI)非典型抗精神病药物， 利培酮微球(Rm)目前的平均批发价约为 每位患者每年8,000美元，比普通的常规LAI制剂(例如，氟奋乃静 Fd)。还没有对RM和FD进行比较的研究来证明这种溢价是合理的。另外两个 非典型的LAI制剂(奥氮平、帕甲酸奥氮平和帕利培酮棕榈酸酯)可能在 来年，我们可以预期，这些新药的积极营销将增加LAI的使用 相当多的抗精神病药物。 建议的研究目的是比较rm和rm的有效性、成本和耐受性。 精神分裂症或分裂情感障碍患者的限制剂量FD(SCH/Schaff)。核心目的 精神分裂症试验网络(STN)的目的是为临床医生和政策制定者提供独立、 目的比较精神分裂症患者的用药情况。 360名SCH/SCHAMF患者将被随机分配到最长42个月的 采用RM或限制剂量FD的盲法治疗。这项试验的主要结果衡量标准是时间 故态复萌。将对服务利用率、精神病理学和不良事件进行反复评估 在整个审判过程中。将获得用于测量血糖、胰岛素、血脂和催乳素的空腹样本。 在整个试验过程中有规律的间隔。 审判将利用NIMH STN基础设施，包括其行政和执行单位，以及 数据管理和分析单位。试验将在25个STN站点进行，代表了广泛的范围 以生成可推广和实用的相关信息。STN将提供 全面监督，确保试验的成功实施，包括快速启动 程序和实施、对高质量数据的实时监控以及高效的数据分析和 手稿准备工作。

PROJECT SUMMARY Concern has developed that marketing, not evidence, drives clinical practice. The use of expensive new medications often extends well beyond their established value. Recent independent, objective comparisons of oral antipsychotic preparations have provided little support for the market saturation achieved by the newer atypical antipsychotic medications. One long-acting injectable (LAI) atypical antipsychotic medication, risperidone microspheres (RM) is currently available at an average wholesale price that is approximately $8,000 per patient per year higher than generic conventional LAI preparations (e.g., fluphenazine decanoate-- FD). No study comparing RM and FD has been conducted that justifies this premium pricing. Two additional atypical LAI preparations (olanzapine pamoate and paliperidone palmitate) may become available within the coming year, and we can expect that aggressive marketing of these new drugs will increase the use of LAI antipsychotics considerably. The objective of the proposed research is to compare the effectiveness, costs, and tolerability of RM and restricted dose FD in patients with schizophrenia or schizo-affective disorder (SCH/SCHAFF). A core purpose of the Schizophrenia Trials Network (STN) is to provide, for clinicians and policy makers, independent, objective comparisons of medications used to treat patients with schizophrenia. Three hundred and sixty (360) patients with SCH/SCHAFF will be randomly assigned to up to 42 months of blinded treatment with either RM or restricted dose FD. The primary outcome measure for this trial will be time to relapse. Repeated assessments of service utilization, psychopathology, and adverse events will be made throughout the trial. Fasting samples for measurement of glucose, insulin, lipids, and prolactin will be obtained at regular intervals throughout the trial. The trial will utilize the NIMH STN infrastructure, including its Administrative and Implementation Units, and Data Management and Analysis Units. The trial will be conducted at 25 STN sites, representing a broad array of clinical settings to generate generalize-able and pragmatically relevant information. The STN will provide comprehensive oversight to ensure the successful implementation of the trial, including rapid start-up procedures and implementation, real-time monitoring for high quality data, and efficient data analysis and manuscript preparation.