精神分裂症門診病人的臨床特徵及治療中斷之研究：「洲際精神分裂症門診病患健康結果研究」中台灣樣本之分析

Patient Characteristics and Treatment Discontinuation in a Taiwanese Cohort of the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) Study

目的：本研究擬報告參與Intercontinental Schizophrenia Outpatient Health Outcomes(IC-SOHO)研究中的台灣病人族群的臨床特徵及治療結果。方法：IC-SOHO研究是一個多國參與、為期三年、前瞻追蹤的自然觀察性研究。此研究是設計來比較門診精神分裂症病人，在開始或轉換抗精神病劑治療之後的臨床結果。所做的評估包括臨床嚴重度及藥物耐受度等。治療開始到中斷的時間以Kaplan-Meier方法來分析。結果：台灣共有300位精神分裂症病人參與本研究，多數病人參與研究時是新開始接受單一抗精神病劑的治療。雖然並未進行隨機分配，各治療分組間的基線人口學及臨床特徵並無顯著差異。在36個月的研究過程中，治療藥物的平均劑量增加且維持高比例的併用藥物。以CGI-S分數的降低為指標，許多病人在各個面向皆顯示對治療有反應。接受Olanzapine治療的病人維持藥物治療的時間，比起接受其他抗精神病劑者的時間較長，但是兩組沒有統計學上的區別。但在接受治療的第一年有顯著較多的體重增加(p=0.0129)。結論：此自然觀察研究對台灣精神分裂病人的臨床特徵及長期使用抗精神病劑的治療結果提供了重要的觀察資料。

Objective: This report was to present the demographic and clinical outcomes of the Taiwanese cohort of the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study for the readership of Taiwanese psychiatrists. Methods: The IC-SOHO was a three-year, naturalistic, prospective, observational study which was designed to compare outcomes of outpatients with schizophrenia who had initiated or changed antipsychotic medications. They were divided into olanzapine and other non-olanzapine antipsychotic groups. Evaluations included clinical severity, social functioning, health-related quality of life, and medication tolerability. Time to treatment discontinuation was analyzed using the Kaplan-Meier method. Results: A total of 300 patients was enrolled in this Taiwanese cohort, and 81.6% (245 patients) of them received initial antipsychotic monotherapy. Despite the absence of randomization in this study, no signifi cant differences were found between the treatment cohorts in the socio-demographic and clinical characteristics at baseline of those two groups. The mean doses of treatments were increased in those two groups over the 36-month period and the uses of non-antipsychotic concomitant medications remained high throughout the study. Patients who remained at the end of the study showed a clinical response to treatment indicated by reductions in CGI-S scores in all domains, but these changes were not signifi cantly different between those two groups. The estimated time to medication discontinuation for 50% of patients was 36.3 (95% CI 31.2, 38.4) months for those in the olanzapine group and 18.0 (95% CI 11.3, 30.1) months for patients receiving other monotherapy; the hazard ratio was 0.65 (95% CI 0.43, 0.99). But their weight gain was signifi cantly greater for the olanzapine group over the fi rst 12 months of treatment. Conclusion: The results of this naturalistic, observational study offer an important description of the clinical characteristics and outcomes associated with the long-term use of antipsychotic treatment of schizophrenia in a cohort of Taiwanese patients.