氯氮平停药后：抗精神病药对停用氯氮平的精神分裂症患者的有效性和安全性的比较,The British Journal of Psychiatry

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氯氮平停药后：抗精神病药对停用氯氮平的精神分裂症患者的有效性和安全性的比较
The British Journal of Psychiatry ( IF 8.7 ) Pub Date : 2020-01-08 , DOI: 10.1192/bjp.2019.267
Jurjen J Luykx ₁ , Noraly Stam ₂ , Antti Tanskanen ₃ , Jari Tiihonen ₄ , Heidi Taipale ₅

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背景尽管氯氮平经常被停用，但关于氯氮平停用后治疗选择的指南和证据却很少。此外，目前尚不清楚是否应避免在以前使用氯氮平的患者中恢复氯氮平。目的比较氯氮平停用后抗精神病药的真实效果。方法根据芬兰注册数据（1995-2017），我们确定了 2250 名在停止治疗前使用氯氮平≥1 年的精神分裂症患者。主要分析包括因精神病和治疗失败而重新入院的精神科病房的调整后的个体内分析。次要分析涉及个体间死亡率差异。结果与不使用抗精神病药相比，重新开始使用氯氮平（调整后的风险比 (aHR) 0.49；95% CI 0.40–0.61；P < 0.0001）、口服奥氮平（aHR 0.58；95% CI 0.48–0.70）和 P < 0.70 的精神科病房再入院风险最低；抗精神病多药治疗（aHR 0.62；95% CI 0.53–0.72；P < 0.0001）。阿立哌唑长效注射剂（aHR 0.42；95% CI 0.27–0.65；P < 0.0001）、重新开始使用氯氮平（aHR 0.49；95% CI 0.43–0.57；P < 0.0001）和口服aHRolanza（口服aHRolanza）的治疗失败风险最低0.69；95% CI 0.61–0.77；P < 0.0001)。重新开始使用氯氮平（aHR 0.18；95% CI 0.09–0.36；P < 0.0001）和口服奥氮平（aHR 0.26；95% CI 0.17–0.40；P < 0.0001）的死亡率风险最低。结论对于因不明原因停用氯氮平的患者，氯氮平和奥氮平是最有效和最安全的治疗选择。

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In the aftermath of clozapine discontinuation: comparative effectiveness and safety of antipsychotics in patients with schizophrenia who discontinue clozapine

Background Although clozapine is often discontinued, there is a paucity of guidelines and evidence on treatment options after clozapine discontinuation. Moreover, it is currently unknown whether reinstating clozapine in patients formerly using clozapine should be avoided. Aims To compare the real-world effectiveness of antipsychotics after clozapine cessation. Method From Finnish registry data (1995–2017), we identified 2250 patients with schizophrenia who had been using clozapine for ≥1 year before treatment cessation. The primary analysis consisted of adjusted within-individual analyses of psychiatric ward readmission owing to psychosis and treatment failure. Secondary analyses concerned between-individual mortality differences. Results Compared with no use of antipsychotics, risk of psychiatric ward readmission was lowest for reinitiation of clozapine (adjusted hazard ratio (aHR) 0.49; 95% CI 0.40–0.61; P < 0.0001), oral olanzapine (aHR 0.58; 95% CI 0.48–0.71; P < 0.0001) and antipsychotic polypharmacy (aHR 0.62; 95% CI 0.53–0.72; P < 0.0001). Risk of treatment failure was lowest for aripiprazole long acting injectable (aHR 0.42; 95% CI 0.27–0.65; P < 0.0001), reinitiation of clozapine (aHR 0.49; 95% CI 0.43–0.57; P < 0.0001) and oral olanzapine (aHR 0.69; 95% CI 0.61–0.77; P < 0.0001). Mortality risk was lowest for reinitiation of clozapine (aHR 0.18; 95% CI 0.09–0.36; P < 0.0001) and oral olanzapine (aHR 0.26; 95% CI 0.17–0.40; P < 0.0001). Conclusions Clozapine and olanzapine are the most effective and safest treatment options in those discontinuing clozapine for undefined reasons. Clozapine should therefore be reconsidered in patients with schizophrenia who previously discontinued this compound.

更新日期：2020-01-08

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