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首页> 外文期刊>The journal of clinical psychiatry >The Use of Long-Acting Injectable Antipsychotics in Schizophrenia: Evaluating the Evidence
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The Use of Long-Acting Injectable Antipsychotics in Schizophrenia: Evaluating the Evidence

机译：长效注射性抗精神病药在精神分裂症中的使用：评估证据。

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Long-acting injectable antipsychotics (LAIs) are among the most effective treatments in psychiatry, yet they remain underutilized in clinical practice. Although LAIs are typically used to maintain treatment adherence in patients with chronic schizophrenia, recent research has suggested that they may also provide an effective treatment strategy for patients with early-phase or first-episode disease. In October 2015, a group of 8 experts on the management of schizophrenia and LAIs met to evaluate the evidence surrounding the efficacy, safety, and cost-effectiveness of LAIs and to develop practical recommendations regarding the clinical use, education, and unmet needs related to LAIs. Participants were also asked to rate the importance of several patient characteristics when choosing an LAI versus an oral antipsychotic, from the perspectives of 4 different stakeholder groups: patients, health care professionals, families, and payers. The evidence review demonstrated that LAIs are superior to placebo for acute and maintenance treatment of schizophrenia and, in general, appear to be similar to one another in terms of schizophrenia relapse prevention. Study design impacts the demonstrated efficacy of LAIs versus oral antipsychotics, but recent database and randomized controlled studies favor the use of LAIs in early-phase schizophrenia patients. LAIs vary considerably in their propensity to cause certain adverse effects, including weight gain, metabolic effects, extrapyramidal symptoms, and prolactin elevation, and these differences can be used to help guide LAI selection. Some studies, but not all, have demonstrated significant reductions in health care utilization or overall costs with LAIs. The expert panel identified several barriers to LAI use in current practice, including clinician lack of knowledge, negative attitudes about LAIs, and resource and cost issues. The participants also identified a number of additional factors that should be considered when weighing the use of LAI therapy, including medication adherence, relapse risk and severity, cognitive impairment, ease of use, substance misuse, access and cost, stigma, social support, patient autonomy, control over medication dosing, fear of needles, and the potential for patient harm due to relapses and associated loss of functioning. This evidence review, discussion, and summary recommendations may help clinicians, patients, families, payers, and other stakeholders to better characterize the role of LAIs in the treatment of schizophrenia.
机译：长效注射抗精神病药（LAIs）是精神病学中最有效的治疗方法之一，但在临床实践中仍未得到充分利用。尽管LAI通常用于维持慢性精神分裂症患者的治疗依从性，但最近的研究表明，它们也可以为早期或首发疾病患者提供有效的治疗策略。 2015年10月，由8位精神分裂症和LAI管理专家组成的小组开会，评估了LAI的功效，安全性和成本效益方面的证据，并就与LAI相关的临床使用，教育和未满足的需求提出了实用建议LAI。还从4个不同的利益相关者群体（患者，医疗保健专业人员，家庭和付款人）的角度，要求参与者在选择LAI与口服抗精神病药时评价几种患者特征的重要性。证据回顾表明，在精神分裂症的急性和维持治疗中，LAI优于安慰剂，并且在预防精神分裂症的复发方面，总体看来彼此相似。研究设计影响了LAIs对口服抗精神病药的疗效，但最近的数据库和随机对照研究均支持在早期精神分裂症患者中使用LAIs。 LAIs引起某些不利影响的倾向差异很大，包括体重增加，代谢影响，锥体束外症状和催乳激素升高，这些差异可用于指导选择LAI。一些研究（但不是全部）已证明，LAI可以显着降低医疗保健利用率或总体成本。专家小组确定了目前实践中使用LAI的几个障碍，包括临床医生缺乏知识，对LAI的否定态度以及资源和成本问题。参与者还确定了在权衡使用LAI治疗时应考虑的许多其他因素，包括药物依从性，复发风险和严重性，认知障碍，易用性，药物滥用，获取和费用，污名，社会支持，患者自主权，对药物剂量的控制，对针头的恐惧以及由于复发和相关功能丧失而可能对患者造成伤害的可能性。该证据审查，讨论和总结建议可能有助于临床医生，患者，家庭，付款人和其他利益相关者更好地表征LAI在精神分裂症治疗中的作用。

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