Background

Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses.

Objective

Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors.

Methods

The STAR Network ‘Depot Study’ was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively.

Results

The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4–44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3–43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4–84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6–40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6–27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742–0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003–4.634; p = 0.049).

Conclusions

Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation.

中文翻译：

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比较普通临床情况下的长效抗精神病药物停药率：一项观察性实用研究的生存分析

背景

最近的指南建议比以前更广泛地使用长效注射抗精神病药 (LAI)，但关于 LAI 使用在停药率和相关因素方面的后果的自然数据仍然很少，这使得临床医生很难了解合理的治疗方法培训班。

客观的

我们的目标是在真实世界的临床情况下评估首次处方后 12 个月内 LAI 的停药率、停药原因和相关因素。

方法

STAR 网络“仓库研究”是一项自然主义、多中心、观察性前瞻性研究，该研究招募了启动 LAI 的受试者，不受诊断、临床严重程度或环境的限制。来自 32 个意大利中心的参与者在基线和 6 个月和 12 个月的随访中进行了评估。分别使用简要精神病评定量表、药物态度量表和坎普量表测量精神病理学、药物态度和治疗依从性。

结果

该研究跟踪了 394 名参与者 12 个月。12 个月时的总停药率为 39.3%（95% 置信区间 [CI] 34.4-44.3），帕利哌酮 LAI 停药最少（33.9%；95% CI 25.3-43.5），奥氮平 LAI 停药最多（62.5 %；95% CI 35.4–84.8)。最常见的停药原因是不良事件的发生（32.9%；95% CI 25.6-40.9），其次是参与者拒绝服药（20.6%；95% CI 14.6-27.9）。基线药物依从性与停药风险呈负相关（风险比 [HR] 0.853；95% CI 0.742–0.981；p  = 0.026），而与处方帕潘立酮 LAI 相比，处方奥氮平 LAI 与增加的停药风险相关（HR 2.156 ; 95% CI 1.003–4.634; p = 0.049)。

结论

临床医生应该意识到 LAI 停药是经常发生的。LAI 的选择应与患者仔细讨论，考虑到个体特征和与每种制剂的实用性相关的可能障碍。