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

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

10.29478/TJP.201006.0005

林喬祥(Chaucer Chiao-Hsiang Lin)；蕭正誠(Cheng-Cheng Hsiao)；黃玉書(Yu-Shu Huang)；呂少鈞(Shao-Chun Ree)；盧孟良(Mong-Liang Lu)；臧汝芬(Ruu-Fen Tzang)；魯思翁(Sy-Ueng Luu)；Teena Maree West；沈武典(Winston W. Shen)

精神分裂症 ； 觀察性研究 ； 治療中斷時間 ； Olanzapine ； schizophrenia ； observational study ； time to discontinuation ； olanzapine

台灣精神醫學

24卷2期（2010 / 06 / 01）

110 - 121

英文

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 significant 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 significantly 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 first 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.

1. Allison, D.B.,Casey, D.E.(2001).Antipsychotic-induced weight gain: a review of the literature.J Clin Psychiatry,62(Suppl 7),22-31.
2. American Psychiatric Association(1997).Practice guideline for the treatment of patients with schizphrenia.Am J Psychiatry,154(Suppl 2),1-63.
3. Ascher-Svanum, H.,Faries, D.E.,Zhu, B.,Ernst, F.R.,Swartz, M.S.,Swanson, J.W.(2006).Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care.J Clin Psychiatry,67,453-60.
4. Basson, B.R.,Kinon, B.J.,Tor, C.C.,Szymanski, K.A.,Gilmore, J.A.,Tollefson, G.D.(2001).Factors influencing acute weight change in patients with schizophrenia treated with olanzapine, haloperidol, or risperidone.J Clin Psychiatry,62,231-8.
5. Bobes, J.,Rejas, J.,Garcia-Garcia, M.(2003).Weight gain in patients with schizophrenia treated with risperidone, olanzapine, quetiapine or haloperidol: results of the EIRE study.Schizophr Res,62,77-88.
6. Corrigan, P.W.,Reinke, R.R.,Landsberger, S.A.,Charate, A.,Toombs, G.A.(2003).The effects of atypical antipsychotic medications on psychosocial outcomes.Schizophr Res,63,97-101.
7. Csernansky, J.G.,Schuchart, E.K.(2002).Relapse and rehospitalisation rates in patients with schizophrenia: effects of second generation antipsychotics.CNS Drugs,16,473-84.
8. EuroQol(1990).a new facility for the measurement of health related quality of life.Health Policy,16,199-208.
9. Haro, J.M.,Kamath, S.A.,Ochoa, S.(2003).The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia.Acta Psychiatr Scand Suppl,16-23.
10. Huang, S.S.,Liao, Y.C.,Hsieh, Y.Y.(2006).Combination antipsychotic therapy in psychiatric outpatients clinics in Taiwan.Compr Psychiatry,47,421-5.
11. Kahn, R.S.,Fleischhacker, W.W.,Boter, H.(2008).Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial.Lancet,371,1085-1097.
12. Keck, P.E. Jr.,Strakowski, S.M.,McElroy, S.L.(2000).The efficacy of atypical antipsychotics in the treatment of depressive symptoms, hostility, and suicidality in patients with schizophrenia.J Clin Psychiatry,61(Suppl 3),4-9.
13. Kelly, D.L.,Conley, R.R.,Carpenter, W.T.(2005).First-episode schizophrenia: a focus on pharmacological treatment and safety considerations.Drugs,65,1113-38.
14. Lee, C.,Wu, K.H.,Habil, H.,Dyachkova, Y.,Lee, P.(2006).Treatment with olanzapine, risperidone or typical antipsychotic drugs in Asian patients with schizophrenia.Aust NZ J Psychiatry,40,437-45.
15. Lee, P.,Kim, C.E.,Kim, C.Y.(2008).Long-term, naturalistic treatment with olanzapine, risperidone, quetiapine, or haloperidol monotherapy: 24-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO).Int J Psychiatry Clinical Practice,12(3),215-277.
16. Lehman, A.F.,Lieberman, J.A.,Dixon, L.B.(2004).Practice guidelines for the treatment of patients with schizophrenia, second edition.Am J Psychiatry,161(Suppl 2),1-56.
17. Lieberman, J.A.,Stroup, S.,McEvoy, J.P.(2005).Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.N Engl J Med,353,1209-23.
18. Lieberman, J.A.,Stroup, T.S.,McEvoy, J.P.(2005).Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.NEJM,353,1209-23.
19. Miyamoto, S.,Duncan, G.E.,Marx, C.E.,Lieberman, J.A.(2005).Treatments for schizophrenia: a critical review of pharmacology and mechanisms of action of antipsychotic drugs.Mol Psychiatry,10,79-104.
20. Saleem, P.,Olie, J.P.,Loo, H.(2002).Social functioning and quality of life in the schizophrenic patient: advantages of amisulpride.Int Clin Psychoparmacol,17,1-8.
21. Sebastian, C.S.,Glazer, W.,Buckley, P.F.(2004).Naturalistic studies of second generation antipsychotics in the treatment of schizophrenia.Curr Med Chem,11,329-42.
22. Shen, W.W.(2002).Antidepressants are under-used in Taiwan.Taiwanese Journal of Psychiatry,16,242-6.
23. Shen, W.W.(1981).A drug information note for patients receiving antiparkinsonian agents.Hosp Community Psychiatry,32,575.
24. Sim, K.,Su, A.,Fuji, S.(2004).Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia.Br J Clin Pharmacol,58,178-83.
25. Su, T.P.,Chen, T.J.,Hwang, S.J.,Chou, L.F.,Fan, A.P.,Chen, Y.C.(2002).Utilization of psychotropic drugs in Taiwan: an overview of outpatient sector in 2000.Chinese Medical Journal,65,378-91.
26. Sullivan, G.,Wells, K.B.,Morgenstern, H.,Leake, B.(1995).Identifying modifiable risk factors for rehospitalization: a case-control study of seriously mentally ill persons in Mississippi.Am J Psychiatry,152,1749-56.
27. Tollefson, G.D.,Sanger, T.M.(1997).Negative symptoms: a path analytic approach to a double-blind, placebo-and haloperidol-controlled clinical trial with olanzapine.Am J Psychiatry,154,466-74.
28. Tran, P.V.,Hamilton, S.H.,Kuntz, A.J.(1997).Double-blind comparison of olanzapine versus risperidone in the treatment of schizophrenia and other psychotic disorders.J Clin Psychopharmacol,17,407-18.
29. Valenstein, M.,Copeland, L.A.,Blow, F.C.(2002).Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission.Med Care,40,630-9.
30. Weiden, P.J.,Mackell, J.A.,McDonnell, D.D.(2004).Obesity as a risk factor for antipsychotic noncompliance.Schizophr Res,66,51-7.

1. Wu, Yu-Hsuan,Lai, Chun-Yang,Huang, Yu-Hui,Huang, Mei-Feng,Chang, Yu-San(2013).Changing Patterns of Antipsychotic Prescription and Concomitant Antiparkinson Drug Use at a Taiwanese Psychiatric Hospital.台灣精神醫學,27(4),306-317.