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首页> 美国卫生研究院文献>World Psychiatry >Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: a population‐based UK cohort study using electronic health records
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Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: a population‐based UK cohort study using electronic health records

机译：锂丙戊酸酯奥氮平与喹硫平作为双相情感障碍的维持单一疗法：一项基于人群的英国队列研究使用电子健康记录

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It is unclear which maintenance treatment for bipolar disorder is superior in clinical practice. Randomized controlled head‐to‐head trials of available drugs either do not exist or are inconclusive. We aimed to compare rates of monotherapy treatment failure in individuals prescribed lithium, valproate, olanzapine or quetiapine by a population‐based cohort study using electronic health records. 5,089 patients with bipolar disorder were prescribed lithium (N=1,505), valproate (N=1,173) olanzapine (N=1,366) or quetiapine (N=1,075) as monotherapy. Treatment failure was defined as time to stopping medication or add‐on of another mood stabilizer, antipsychotic, antidepressant or benzodiazepine. In unadjusted analyses, the duration of successful monotherapy was longest in individuals treated with lithium. Treatment failure had occurred in 75% of those prescribed lithium by 2.05 years (95% CI: 1.63‐2.51), compared to 0.76 years (95% CI: 0.64‐0.84) for those prescribed quetiapine, 0.98 years (95% CI: 0.84‐1.18) for those prescribed valproate, and 1.13 years for those prescribed olanzapine (95% CI: 1.00‐1.31). Lithium's superiority remained in a propensity score matched analysis; when treatment failure was defined as stopping medication or add‐on of a mood stabilizer or antipsychotic; and when treatment failure was restricted to more than three months after commencing the study drug. Lithium appears to be more successful as monotherapy maintenance treatment than valproate, olanzapine or quetiapine. Lithium is often avoided because of its side effect profile, but alternative treatments may reduce the time to being prescribed more than one drug, with potential additive side effects of these treatments.
机译：目前尚不清楚哪种双相情感障碍的维持治疗在临床实践中会更好。不存在或尚无定论的可用药物随机对照试验。我们旨在通过一项基于电子健康记录的基于人群的队列研究，比较处方锂，丙戊酸，奥氮平或喹硫平个体患者的单药治疗失败率。 5,089例躁郁症患者接受了单药治疗，其中锂（N = 1,505），丙戊酸（N = 1,173），奥氮平（N = 1,366）或喹硫平（N = 1,075）。治疗失败的定义是停止药物治疗或补充另一种情绪稳定剂，抗精神病药，抗抑郁药或苯二氮卓的时间。在未经调整的分析中，接受锂治疗的个体成功进行单药治疗的时间最长。处方锂的2.05年（75％CI：1.63-2.51）中有75％发生了治疗失败，而喹硫平的0.98年（95％CI：0.84）为0.76年（95％CI：0.64-0.84）。 -处方为丙戊酸盐的患者为-1.18年，奥氮平的处方患者为1.13年（95％CI：1.00-1.31）。锂的优越性仍在倾向得分匹配分析中。当治疗失败被定义为停止药物治疗或添加情绪稳定剂或抗精神病药时；并且在开始研究药物后将治疗失败限制在三个月以上。锂似乎比丙戊酸，奥氮平或喹硫平在单一疗法维持治疗中更成功。由于锂的副作用，通常可以避免使用锂，但是替代疗法可以减少开具多于一种药物的处方时间，并且这些疗法具有潜在的附加副作用。

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