早期和一次性的立即与延期抗药物治疗:一个随机对照试验
Lancet (London, England)
|June 14, 2005
概括
开始抗药物治疗及时减少发作复发在短期内,对于少数发作的患者. 然而,与延迟治疗相比,立即治疗并不能改善长期发作缓解率.
科学领域:
- 神经学 神经学
- 临床药理学 临床药理学
背景情况:
- 在几次或不经常发作的患者中,启动抗药物 (AED) 治疗的最佳时间仍然不确定.
- 立即与延迟的AED治疗的风险和益处的比较需要澄清.
研究的目的:
- 在单次发作和早期患者中比较即时与延迟AED治疗政策.
- 评估这些政策对短期发作复发和长期结果的影响.
主要方法:
- 一项无面具,多中心,随机的研究,涉及1847名单次发作或早期患者.
- 评估的结果包括第一,第二和第五次发作的时间,2年缓解的时间,随机化后1-3至3-5年间的发作自由度和生活质量.
- 使用了治疗意向分析.
主要成果:
- 立即AED治疗显著增加了第一次发作的时间 (HR 1.4),第二次发作 (HR 1.3),以及第一次强力-克隆性发作 (HR 1.5).
- 立即治疗也加速了达到2年的缓解 (p=0.023).
- 在立即和延期治疗组之间,没有观察到长期无发作 (3-5年) 或生活质量的显著差异.
结论:
- 立即的AED治疗有效地减少了第一次发作或早期的诊断后的最初1-2年内发作的发生.
- 在这种患者群体中,立即或延迟AED治疗之间的选择似乎没有影响长期缓解率.
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