PDF(Pubmed)
Abstract：
UNASSIGNED: Discontinuation of treatment in people with first episode psychosis (FEP) is common, but the extent to which this is related to specific adverse effects of antipsychotic medications is unclear.
UNASSIGNED: To investigate whether antipsychotic discontinuation is associated with the prescription of particular antipsychotics and particular adverse effects.
UNASSIGNED: Retrospective cohort study.
UNASSIGNED: We assembled de-identified electronic health record (EHR) data from 2309 adults with FEP who received care from the South London and Maudsley NHS Foundation Trust between 1st April 2008 and 31st March 2019. Associations between antipsychotic medications, clinician-recorded side effects and treatment discontinuation were investigated across a mean follow-up period of 34.2 months using Cox regression.
UNASSIGNED: The mean age of patients was 26.7 years and 1492 (64.6%) were male. Among first prescribed antipsychotic medications, discontinuation occurred earlier with haloperidol [hazard ratio (HR) = 2.78, 95% CI = 1.69-4.60] and quetiapine (HR = 1.43, 95% CI = 1.16-1.80) than with olanzapine. Discontinuation occurred sooner when there was evidence of extrapyramidal symptoms (HR = 1.33, 95% CI = 1.08-1.64) or sexual dysfunction (HR = 1.59, 95% CI = 1.03-2.46). Among antipsychotics prescribed at any point during treatment, lurasidone (HR = 1.40, 95% CI = 1.10-1.78) and aripiprazole (HR = 1.09, 95% CI = 1.01-1.19) were associated with earlier discontinuation than olanzapine. Conversely, clozapine (HR = 0.55, 95% CI = 0.41-0.73) and paliperidone 1-monthly (PP1M) long-acting injectable (HR = 0.80, 95% CI = 0.68-0.94) were associated with later discontinuation. Unexpectedly, for antipsychotics prescribed at any stage of treatment, sedation (HR = 0.89, 95% CI = 0.81-0.97), weight gain (HR = 0.73, 95% CI = 0.64-0.83), and multiple side effects (HR = 0.83, 95% CI = 0.76-0.90) were associated with later discontinuation.
UNASSIGNED: Earlier treatment discontinuation associated with sexual or extrapyramidal side effects could be related to their rapid onset and poor tolerability. Later treatment discontinuation associated with clozapine and PP1M could be related to the relative efficacy of these treatments. These findings merit consideration when selecting antipsychotic therapy for people with FEP.
UNASSIGNED: To investigate whether antipsychotic discontinuation is associated with the prescription of particular antipsychotics and particular adverse effects.
UNASSIGNED: Retrospective cohort study.
UNASSIGNED: We assembled de-identified electronic health record (EHR) data from 2309 adults with FEP who received care from the South London and Maudsley NHS Foundation Trust between 1st April 2008 and 31st March 2019. Associations between antipsychotic medications, clinician-recorded side effects and treatment discontinuation were investigated across a mean follow-up period of 34.2 months using Cox regression.
UNASSIGNED: The mean age of patients was 26.7 years and 1492 (64.6%) were male. Among first prescribed antipsychotic medications, discontinuation occurred earlier with haloperidol [hazard ratio (HR) = 2.78, 95% CI = 1.69-4.60] and quetiapine (HR = 1.43, 95% CI = 1.16-1.80) than with olanzapine. Discontinuation occurred sooner when there was evidence of extrapyramidal symptoms (HR = 1.33, 95% CI = 1.08-1.64) or sexual dysfunction (HR = 1.59, 95% CI = 1.03-2.46). Among antipsychotics prescribed at any point during treatment, lurasidone (HR = 1.40, 95% CI = 1.10-1.78) and aripiprazole (HR = 1.09, 95% CI = 1.01-1.19) were associated with earlier discontinuation than olanzapine. Conversely, clozapine (HR = 0.55, 95% CI = 0.41-0.73) and paliperidone 1-monthly (PP1M) long-acting injectable (HR = 0.80, 95% CI = 0.68-0.94) were associated with later discontinuation. Unexpectedly, for antipsychotics prescribed at any stage of treatment, sedation (HR = 0.89, 95% CI = 0.81-0.97), weight gain (HR = 0.73, 95% CI = 0.64-0.83), and multiple side effects (HR = 0.83, 95% CI = 0.76-0.90) were associated with later discontinuation.
UNASSIGNED: Earlier treatment discontinuation associated with sexual or extrapyramidal side effects could be related to their rapid onset and poor tolerability. Later treatment discontinuation associated with clozapine and PP1M could be related to the relative efficacy of these treatments. These findings merit consideration when selecting antipsychotic therapy for people with FEP.
摘要：
■首次发作精神病（FEP）患者停止治疗很常见，但这与抗精神病药物的特定不良反应相关的程度尚不清楚.
■研究抗精神病药停药是否与特定抗精神病药的处方和特定不良反应有关。
■回顾性队列研究。
我们收集了2309名患有FEP的成年人的去识别电子健康记录（EHR）数据，他们在2008年4月1日至2019年3月31日期间接受了南伦敦和莫兹利NHS基金会信托基金的护理。抗精神病药物之间的关联，在平均34.2个月的随访期间,使用Cox回归对临床医生记录的副作用和治疗中断进行了调查.
■患者的平均年龄为26.7岁，男性为1492人（64.6%）。在第一批处方抗精神病药物中，氟哌啶醇[风险比(HR)=2.78,95%CI=1.69-4.60]和喹硫平(HR=1.43,95%CI=1.16-1.80)停药比奥氮平停药更早.当存在锥体外系症状（HR=1.33，95％CI=1.08-1.64）或性功能障碍（HR=1.59，95％CI=1.03-2.46）时，停药发生较早。在治疗期间的任何时候规定的抗精神病药物中，鲁拉西酮（HR=1.40，95％CI=1.10-1.78）和阿立哌唑（HR=1.09，95％CI=1.01-1.19）与奥氮平更早的停药有关。相反，氯氮平（HR=0.55，95％CI=0.41-0.73）和帕潘立酮1个月（PP1M）长效注射剂（HR=0.80，95％CI=0.68-0.94）与后期停药有关。出乎意料的是,对于在任何治疗阶段开出的抗精神病药，镇静（HR=0.89，95%CI=0.81-0.97），体重增加(HR=0.73，95%CI=0.64-0.83)，和多个副作用（HR=0.83，95％CI=0.76-0.90）与后期停药有关。
■与性或锥体外系副作用相关的早期停药可能与它们的快速起效和耐受性差有关。与氯氮平和PP1M相关的后期治疗中断可能与这些治疗的相对功效有关。在为FEP患者选择抗精神病药物治疗时，这些发现值得考虑。
■研究抗精神病药停药是否与特定抗精神病药的处方和特定不良反应有关。
■回顾性队列研究。
我们收集了2309名患有FEP的成年人的去识别电子健康记录（EHR）数据，他们在2008年4月1日至2019年3月31日期间接受了南伦敦和莫兹利NHS基金会信托基金的护理。抗精神病药物之间的关联，在平均34.2个月的随访期间,使用Cox回归对临床医生记录的副作用和治疗中断进行了调查.
■患者的平均年龄为26.7岁，男性为1492人（64.6%）。在第一批处方抗精神病药物中，氟哌啶醇[风险比(HR)=2.78,95%CI=1.69-4.60]和喹硫平(HR=1.43,95%CI=1.16-1.80)停药比奥氮平停药更早.当存在锥体外系症状（HR=1.33，95％CI=1.08-1.64）或性功能障碍（HR=1.59，95％CI=1.03-2.46）时，停药发生较早。在治疗期间的任何时候规定的抗精神病药物中，鲁拉西酮（HR=1.40，95％CI=1.10-1.78）和阿立哌唑（HR=1.09，95％CI=1.01-1.19）与奥氮平更早的停药有关。相反，氯氮平（HR=0.55，95％CI=0.41-0.73）和帕潘立酮1个月（PP1M）长效注射剂（HR=0.80，95％CI=0.68-0.94）与后期停药有关。出乎意料的是,对于在任何治疗阶段开出的抗精神病药，镇静（HR=0.89，95%CI=0.81-0.97），体重增加(HR=0.73，95%CI=0.64-0.83)，和多个副作用（HR=0.83，95％CI=0.76-0.90）与后期停药有关。
■与性或锥体外系副作用相关的早期停药可能与它们的快速起效和耐受性差有关。与氯氮平和PP1M相关的后期治疗中断可能与这些治疗的相对功效有关。在为FEP患者选择抗精神病药物治疗时，这些发现值得考虑。
