背景:近年来双相情感障碍的药物治疗模式发生了变化,
目的:研究抗精神病药物和情绪稳定剂在双相情感障碍中的比较真实世界有效性。
方法:基于注册的队列研究,包括所有16-65岁的芬兰居民,在住院护理中诊断为双相情感障碍,专业门诊护理,病假和残疾养恤金在1996年至2018年之间登记,平均随访时间为9.3年(标准差=6.4)。使用PRE2DUP方法对抗精神病药和情绪稳定剂的使用进行建模,并使用个体内部Cox模型估计使用和不使用药物时,因精神病和非精神病原因入院的风险。
结果:在60045名个体中(56.4%为女性;平均年龄41.7岁,s.d.=15.8),与精神病住院风险最低相关的五种药物是奥氮平长效注射剂(LAI)(aHR=0.54,95%CI0.37-0.80),氟哌啶醇LAI(AHR=0.62,0.47-0.81),zuclopenthixolLAI(aHR=0.66,95%CI0.52-0.85),锂(aHR=0.74,95%CI0.71-0.76)和氯氮平(aHR=0.75,95%CI0.64-0.87)。只有齐拉西酮(aHR=1.26,95%CI1.07-1.49)与统计学上较高的风险相关。对于非精神病(躯体)入院,只有锂(aHR=0.77,95%CI0.74-0.81)和卡马西平(aHR=0.91,95%CI0.85-0.97)与风险显着降低相关,而普瑞巴林,加巴喷丁和几种口服抗精神病药,包括喹硫平,与风险增加有关。首发患者亚队列的结果(26395人,54.9%女性;平均年龄38.2岁,s.d.=13.0)与总队列一致。
结论:锂和某些LAI抗精神病药物与精神病患者入院风险最低相关。锂是与降低精神病和躯体入院风险相关的唯一治疗方法。
Pharmacological treatment patterns for bipolar disorder have changed during recent years, but for better or worse?
To investigate the comparative real-world effectiveness of antipsychotics and mood stabilisers in bipolar disorder.
Register-based cohort study including all Finnish residents aged 16-65 with a diagnosis of bipolar disorder from in-patient care, specialised out-patient care, sickness absence and disability pensions registers between 1996 and 2018, with a mean follow-up of 9.3 years (s.d. = 6.4). Antipsychotic and mood stabiliser use was modelled using the PRE2DUP method and risk for hospital admission for psychiatric and non-psychiatric reasons when using versus not using medications was estimated using within-individual Cox models.
Among 60 045 individuals (56.4% female; mean age 41.7 years, s.d. = 15.8), the five medications associated with lowest risk of psychiatric admissions were olanzapine long-acting injection (LAI) (aHR = 0.54, 95% CI 0.37-0.80), haloperidol LAI (aHR = 0.62, 0.47-0.81), zuclopenthixol LAI (aHR = 0.66, 95% CI 0.52-0.85), lithium (aHR = 0.74, 95% CI 0.71-0.76) and clozapine (aHR = 0.75, 95% CI 0.64-0.87). Only ziprasidone (aHR = 1.26, 95% CI 1.07-1.49) was associated with a statistically higher risk. For non-psychiatric (somatic) admissions, only lithium (aHR = 0.77, 95% CI 0.74-0.81) and carbamazepine (aHR = 0.91, 95% CI 0.85-0.97) were associated with significantly reduced risk, whereas pregabalin, gabapentin and several oral antipsychotics, including quetiapine, were associated with an increased risk. Results for a subcohort of first-episode patients (26 395 individuals, 54.9% female; mean age 38.2 years, s.d. = 13.0) were in line with those of the total cohort.
Lithium and certain LAI antipsychotics were associated with lowest risks of psychiatric admission. Lithium was the only treatment associated with decreased risk of both psychiatric and somatic admissions.