使用二代抗精神疾病藥品之精神分裂病患換回一代藥後對其不良反應事件風險的影響   全文下載

Effect of Backward Medication Switching on the Risks of Adverse Events of Schizophrenia Patients Using Atypical Antipsychotics

過去已有許多研究在探討由一代抗精神疾病用藥換為二代抗精神用藥的影響，然而較少評估二代藥轉換成一代藥對病人健康之影響。本研究旨在瞭解已使用二代藥品的精神分裂病患在處方型態改變（由二代換為一代藥品）或二代用藥減量時，其不良反應事件之風險是否會增加。本研究以為期三年的全國性世代追蹤資料，針對12,107 位使用二代抗精神疾病藥品且在固定醫院就醫的精神分裂症病患，比較暴露組（2003 年更換藥品或減少二代藥劑量）的病患，其2004 年發生不良事件（急診及住院）的風險是否較未暴露組為高。資料來源為衛生署提供之全民健保申報資料。在控制其他因素下，以Cox 重複發生事件對比涉險模式估計不良事件發生的危險比。研究結果發現在控制病患及醫院特性後，暴露組病患在2004 年發生急診及住院的風險為未暴露組病患的1.15 倍（HR=1.15, （1.00-1.31））。更換二代藥品或減少二代藥品劑量可能會增加已使用二代藥品之精神分裂症患者發生不良事件的風險。"

Many studies explore the effects of medication switching from second generation antipsychotic (SGA) to first generation antipsychotic (FGA), yet few exam the health effect of backward medication switching. This study investigated whether backward medication switching (from SGA to FGA) and reduced dosages on SGA increased adverse events in outpatient schizophrenia patients treated by SGA in Taiwan. This study applied a three-year historical cohort design and compared the risks of adverse events (outcome) in 2004, measured by emergency room and hospital admissions, of patients experienced backward medication switching or dosage reduction on SGA (exposure status) in 2003 with those who did not (control group). This study was based on a national fixed cohort (census) of 12,107 patients who have ever received SGA during the study period and used hospitals as regular source of care during 2002-2004. Most data were drawn from National Health Insurance claims provided by Department of Health. Cox proportional hazards model for recurrent events using Prentice, Williams and Peterson total-time approach was applied to estimate the hazard ratio (HR) of adverse events by exposure status of the patients while controlling the covariates. The results showed that backward medication switching in 2003 significantly increased the risk of emergency room or hospital admissions (HR=1.15, 1.00-1.31) in 2004. Backward medication switching and reduced dosages on SGA might increase the risk of adverse events of the schizophrenia patients treated by SGA in Taiwan.