背景:抗精神病药物仍然是精神分裂症治疗的主要药物;然而,它们的有效性受到质疑,并且无法预测个体患者对特定抗精神病药物的反应。因此,重要的是比较各种抗精神病药物的有效性并寻找可能的反应预测因子.
目的:研究抗精神病药物的有效性,我们检查了属于不同轨迹组的响应轨迹和预测因子。
方法:卑尔根-斯塔万格-因斯布鲁克-特隆赫姆(BeStInTro)试验比较了三种非典型抗精神病药-氨磺必利的有效性,阿立哌唑,和奥氮平——在一个潜在的,半随机化,率评估者盲,头对头设计。患有精神分裂症谱系障碍诊断的成年参与者,根据国际疾病分类,包括第十次修订(ICD-10)F20-29。参与者被跟踪了12个月,在基线时进行评估;在一次之后,三个和六个星期;三个星期后,六,9和12个月对我们的数据拟合了潜在类混合模型。发现基于阳性和阴性综合征量表(PANSS)总分降低的三轨迹模型具有足够的拟合度,和研究药物,以及各种人口统计学和临床参数,作为属于不同轨迹组的预测因子进行了测试。
结果:总体而言,包括144名参与者,41%完成了12个月的学习期。最大的轨迹组,由74%的参与者组成,显示PANSS总分从基线降低59%至12个月(良好反应组)。由13%的参与者组成的轨迹组的PANSS总分在12个月时降低了82.5%(强烈反应组),而由13%的参与者组成的最后一个反应轨迹组的PANSS总分降低了13.6%(轻微反应组).良好和强烈反应组的总减少的最大部分发生在治疗的六周。从基线减少45%和48%,分别。氨磺必利的使用预测属于强反应组,而失业,抑郁症,基线时的阴性精神病症状增加了属于轻度反应组的机会,表明抗精神病药物治疗反应不佳。
结论:大多数参与者(87%)在一年后取得了良好的结果。Amisulupy用户,比阿立哌唑和奥氮平使用者更常见,属于反应性较强的反应轨迹组。
BACKGROUND: Antipsychotic drugs remain the mainstay of schizophrenia treatment; however, their effectiveness has been questioned, and it is not possible to predict the response to a specific antipsychotic drug in an individual patient. Thus, it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.
OBJECTIVE: To investigate the effectiveness of antipsychotic drugs, we examined response trajectories and predictors for belonging to different trajectory groups.
METHODS: The Bergen-Stavanger-Innsbruck-Trondheim (BeSt InTro)
trial compared the effectiveness of three atypical antipsychotics-amisulpride, aripiprazole, and olanzapine-in a prospective, semirandomized, rater-blind, head-to-head design. Adult participants with a schizophrenia spectrum disorder diagnosis, according to international classification of diseases, Tenth Revision (ICD-10) F20-29, were included. Participants were followed for a period of 12 mo, with assessments at baseline; after one, three and six weeks; and after three, six, nine and 12 mo. A latent class mixed model was fitted to our data. The three-trajectory model based on the Positive and Negative Syndrome Scale (PANSS) total score reduction was found to have adequate fit, and the
study drugs, as well as various demographic and clinical parameters, were tested as predictors for belonging to the different trajectory groups.
RESULTS: Overall, 144 participants were included, and 41% completed the 12-mo
study period. The largest trajectory group, consisting of 74% of participants, showed a PANSS total score reduction of 59% from baseline to 12 mo (Good response group). A trajectory group comprising 13% of participants had their PANSS total score reduced by 82.5% at 12 mo (Strong response group), while the last response trajectory group comprising 13% of the participants had a PANSS total score reduction of 13.6% (Slight response group). The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment, amounting to 45% and 48% reductions from baseline, respectively. The use of amisulpride predicted belonging to the Strong response group, while unemployment, depression, and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group, indicating a poor response to antipsychotic drug treatment.
CONCLUSIONS: Most of the participants (87%) had a good outcome after one year. Amisulpride users, more often than aripiprazole and olanzapine users, belonged to the response trajectory group with a strong response.