■基于专家共识的临床等效剂量估算和剂量建议可以为在临床实践和研究中使用精神病药物提供有价值的支持。
■这第二个抗精神病药物给药的国际共识研究提供了精神病新药和以前报道的低共识药物的等效剂量和建议。
■我们使用两步Delphi调查过程来建立和更新共识,国际临床和研究专家样本,关于26种药物制剂,以获得给药建议(开始,目标范围,和最大)以及用于治疗精神分裂症的临床等效剂量的估计。等效剂量估计的参考药物为口服奥氮平20mg/天,用于15种口服和7种长效注射剂(LAI),肌内氟哌啶醇5mg用于4种短效注射剂(SAI)。我们还提供了一个当代的等效估计和剂量建议的列表,共44口服,16LAI,和14种治疗精神病的SAI药物。
■来自24个国家的调查参与者(N=72)提供了等效性估计和口服剂量建议,LAI,和SAI配方。共识从调查第一阶段到第二阶段有所改善。LAI配方的最终共识最高,口服药物的中间体,和最低的SAI制剂的精神病药物。
■作为随机化,控制,固定,优化精神病药物剂量的多剂量试验仍然很少见,专家共识仍然是估计临床剂量当量的有用替代方法.目前的发现可以支持临床实践,指导方针发展,以及涉及精神病药物的研究设计和解释。
Expert
consensus-based clinically equivalent dose estimates and dosing recommendations can provide valuable support for the use of drugs for psychosis in clinical practice and research.
This second International
Consensus Study of Antipsychotic Dosing provides dosing equivalencies and recommendations for newer drugs for psychosis and previously reported drugs with low
consensus.
We used a two-step Delphi survey process to establish and update consensus with a broad, international sample of clinical and research experts regarding 26 drug formulations to obtain dosing recommendations (start, target range, and maximum) and estimates of clinically equivalent doses for the treatment of schizophrenia. Reference agents for equivalent dose estimates were oral olanzapine 20 mg/day for 15 oral and 7 long-acting injectable (LAI) agents and intramuscular haloperidol 5 mg for 4 short-acting injectable (SAI) agents. We also provide a contemporary list of equivalency estimates and dosing recommendations for a total of 44 oral, 16 LAI, and 14 SAI drugs for psychosis.
Survey participants (N = 72) from 24 countries provided equivalency estimates and dosing recommendations for oral, LAI, and SAI formulations.
Consensus improved from survey stages I to II. The final consensus was highest for LAI formulations, intermediate for oral agents, and lowest for SAI formulations of drugs for psychosis.
As randomized, controlled, fixed, multiple-dose trials to optimize the dosing of drugs for psychosis remain rare, expert consensus remains a useful alternative for estimating clinical dosing equivalents. The present findings can support clinical practice,
guideline development, and research design and interpretation involving drugs for psychosis.