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Real-World Effectiveness of Menopausal Hormone Therapy in Preventing Relapse in Women With Schizophrenia or Schizoaffective Disorder.
American Journal of Psychiatry ( IF 15.1 ) Pub Date : 2024-09-12 , DOI: 10.1176/appi.ajp.20230850
Bodyl A Brand 1 , Iris E Sommer 1 , Shiral S Gangadin 1 , Antti Tanskanen 1 , Jari Tiihonen 1 , Heidi Taipale 1
Affiliation  

OBJECTIVE Antipsychotic effectiveness in preventing relapse declines around menopausal age in women with schizophrenia or schizoaffective disorder (SSD). It is not known whether systemic menopausal hormone therapy (MHT) can help to prevent psychosis relapse. METHODS A within-subject study design was used to study the effectiveness of MHT in preventing relapse in a Finnish nationwide cohort of women with SSD between 40 and 62 years of age who used MHT during follow-up (1994-2017). Hazard ratios adjusted for age and psychotropic drug use were calculated for psychosis relapse as main outcome and any psychiatric hospitalization as secondary outcome. RESULTS The study population comprised 3,488 women using MHT. Use of MHT was associated with a 16% lower relapse risk (adjusted hazard ratio [aHR]=0.84, 95% CI=0.78-0.90) when compared to non-use. Stratified by age, MHT was associated with decreased relapse risks when used between ages 40-49 (aHR=0.86, 95% CI=0.78-0.95) and ages 50-55 (aHR=0.74, 95% CI=0.66-0.83), but not between ages 56-62 (aHR=1.11, 95% CI=0.91-1.37). Similar effectiveness was found for estrogen alone or combined with fixed or sequential progestogens (aHRs between 0.79 and 0.86), transdermal and oral formulations (aHRs 0.75-0.87), and for most specific formulations (aHRs 0.75-0.85), except tibolone (aHR=1.04, 95% CI=0.75-1.44) and formulations with dydrogesterone (aHR=1.05, 95% CI=0.85-1.30). Similar results were observed with any psychiatric hospitalization as outcome measure. CONCLUSIONS The findings underscore the potential value of MHT in preventing psychosis relapse among women with SSD of menopausal age. These findings translate clinical evidence on the neuroprotective effects of estrogens to real-world settings, encompassing a group of women for whom current antipsychotic treatment options may be insufficient.

中文翻译:


更年期激素疗法在预防精神分裂症或分裂情感障碍女性复发方面的现实有效性。



目的 抗精神病药预防绝经期左右精神分裂症或分裂情感性障碍 (SSD) 女性复发的有效性下降。目前尚不清楚全身性绝经激素疗法(MHT)是否有助于预防精神病复发。方法 采用受试者内研究设计来研究 MHT 在芬兰全国 40 至 62 岁 SSD 女性队列中预防复发的有效性,这些女性在随访期间(1994-2017 年)使用了 MHT。根据年龄和精神药物使用调整的风险比被计算为精神病复发作为主要结果和任何精神病住院作为次要结果。结果 研究人群包括 3,488 名使用 MHT 的女性。与不使用相比,使用 MHT 的复发风险降低 16%(调整后风险比 [aHR]=0.84,95% CI=0.78-0.90)。按年龄分层,在 40-49 岁(aHR=0.86,95% CI=0.78-0.95)和 50-55 岁(aHR=0.74,95% CI=0.66-0.83)之间使用 MHT 与复发风险降低相关。但不在 56-62 岁之间(aHR=1.11,95% CI=0.91-1.37)。单独使用雌激素或与固定或序贯孕激素联合使用(aHR 在 0.79 至 0.86 之间)、透皮和口服制剂(aHR 0.75-0.87)以及大多数特定制剂(aHR 0.75-0.85)也有类似的效果,但替勃龙除外(aHR= 1.04,95% CI=0.75-1.44)和地屈孕酮制剂(aHR=1.05,95% CI=0.85-1.30)。作为结果衡量标准的任何精神病住院治疗都观察到类似的结果。结论 研究结果强调了 MHT 在预防绝经年龄 SSD 女性精神病复发方面的潜在价值。 这些发现将雌激素神经保护作用的临床证据转化为现实世界的环境,包括一组目前的抗精神病治疗方案可能不足以满足其需求的女性。
更新日期:2024-09-12
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