Abstract：
Good adherence to antipsychotic therapy helps prevent relapses in first-episode psychosis (FEP). We used data from the FEP-CAUSAL Collaboration, an international consortium of observational cohorts, to emulate a target trial comparing antipsychotics, with treatment discontinuation as the primary outcome. Other outcomes included all-cause hospitalization. We benchmarked our results to estimates from the European First Episode Schizophrenia Trial, a randomized trial conducted in the 2000s. We included 1097 patients with a psychotic disorder and less than 2 years since psychosis onset. Inverse-probability weighting was used to control for confounding. The estimated 12-month risks of discontinuation for aripiprazole, first-generation agents, olanzapine, paliperidone, quetiapine, and risperidone were 61.5% (95% CI, 52.5-70.6), 73.5% (95% CI, 60.5-84.9), 76.8% (95% CI, 67.2-85.3), 58.4% (95% CI, 40.4-77.4), 76.5% (95% CI, 62.1-88.5), and 74.4% (95% CI, 67.0-81.2), respectively. Compared with aripiprazole, the 12-month risk differences were -15.3% (95% CI, -30.0 to 0.0) for olanzapine, -12.8% (95% CI, -25.7 to -1.0) for risperidone, and 3.0% (95% CI, -21.5 to 30.8) for paliperidone. The 12-month risks of hospitalization were similar between agents. Our estimates support use of aripiprazole and paliperidone as first-line therapies for FEP. Benchmarking yielded similar results for discontinuation and absolute risks of hospitalization as in the original trial, suggesting that data from the FEP-CAUSAL Collaboration sufficed to remove confounding for these clinical questions. This article is part of a Special Collection on Mental Health.
摘要：
良好的抗精神病药物治疗依从性有助于预防首发精神病（FEP）的复发。我们使用了FEP-CAUSAL合作组织的数据，一个由观察性队列组成的国际联盟，以模拟一项目标试验，将抗精神病药物与治疗中止作为主要结局进行比较。其他结果包括全因住院。我们将结果与EUFEST的估计进行了基准测试，2000年代进行的一项随机试验。我们纳入了1097名精神病患者，自精神病发作以来不到2年。使用逆概率加权来控制混杂。阿立哌唑停药12个月的估计风险，第一代特工,奥氮平,帕潘立酮,喹硫平,利培酮（95%CI）为：61.5%（52.5-70.6），73.5%（60.5-84.9），76.8%（67.2-85.3），58.4%（40.4-77.4），76.5%（62.1-88.5），和74.4%（67.0-81.2）。与阿立哌唑相比，奥氮平的12个月风险差异(95%CI)为-15.3%(-30.0,0.0),利培酮-12.8%（-25.7，-1.0），帕利哌酮为3.0%（-21.5，30.8）。两种药物的12个月住院风险相似。我们的估计支持使用阿立哌唑和帕潘立酮作为FEP的一线疗法。基准测试结果与原始试验中的停药和绝对住院风险相似。这表明来自FEP-CAUSAL协作数据的数据足以大致消除这些临床问题的混杂因素.
