Objective:

Effectiveness of antipsychotic drugs is inferred from relatively small randomized clinical trials conducted with carefully selected and monitored participants. This evidence is not necessarily generalizable to individuals treated in daily clinical practice. The authors compared the clinical effectiveness between all oral and long-acting injectable (LAI) antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs (VA) health care system.

Methods:

This was an observational study utilizing VA pharmacy data from 37,368 outpatient veterans with schizophrenia. Outcome measures were all-cause antipsychotic discontinuation and psychiatric hospitalizations. Oral olanzapine was used as the reference group.

Results:

In multivariable analysis, clozapine (hazard ratio=0.43), aripiprazole long-acting injectable (LAI) (hazard ratio=0.71), paliperidone LAI (hazard ratio=0.76), antipsychotic polypharmacy (hazard ratio=0.77), and risperidone LAI (hazard ratio=0.91) were associated with reduced hazard of discontinuation compared with oral olanzapine. Oral first-generation antipsychotics (hazard ratio=1.16), oral risperidone (hazard ratio=1.15), oral aripiprazole (hazard ratio=1.14), oral ziprasidone (hazard ratio=1.13), and oral quetiapine (hazard ratio=1.11) were significantly associated with an increased risk of discontinuation compared with oral olanzapine. No treatment showed reduced risk of psychiatric hospitalization compared with oral olanzapine; quetiapine was associated with a 36% worse outcome in terms of hospitalizations compared with olanzapine.

Conclusions:

In a national sample of veterans with schizophrenia, those treated with clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy continued the same antipsychotic therapy for a longer period of time compared with the reference drug. This may reflect greater overall acceptability of these medications in clinical practice.

中文翻译：

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美国退伍军人事务部精神分裂症退伍军人中止抗精神病药物治疗的差异

客观的：

抗精神病药物的有效性是从精心挑选和监测的参与者进行的相对较小的随机临床试验中推断出来的。该证据不一定适用于在日常临床实践中接受治疗的个体。作者比较了美国退伍军人事务部 (VA) 医疗保健系统中用于治疗精神分裂症的所有口服和长效注射 (LAI) 抗精神病药物的临床疗效。

方法：

这是一项观察性研究，利用来自 37,368 名精神分裂症门诊退伍军人的 VA 药房数据。结果测量是全因抗精神病药停药和精神病住院。口服奥氮平作为参考组。

结果：

在多变量分析中，氯氮平（风险比=0.43）、阿立哌唑长效注射剂（LAI）（风险比=0.71）、帕利哌酮LAI（风险比=0.76）、抗精神病药联合用药（风险比=0.77）和利培酮LAI（风险ratio=0.91）与口服奥氮平相比，停药风险降低。口服第一代抗精神病药（危险比=1.16）、口服利培酮（危险比=1.15）、口服阿立哌唑（危险比=1.14）、口服齐拉西酮（危险比=1.13）和口服喹硫平（危险比=1.11）与口服奥氮平相比，停药风险增加。与口服奥氮平相比，没有任何治疗显示精神病住院风险降低；与奥氮平相比，喹硫平的住院结局差 36%。

结论：

在全国精神分裂症退伍军人样本中，与参考药物相比，接受氯氮平、两种 LAI 第二代抗精神病药和抗精神病药联合治疗的患者继续使用相同的抗精神病药物治疗的时间更长。这可能反映了这些药物在临床实践中的整体可接受性更高。