第二代抗精神病药物不同治疗序列对代谢结果的长度影响:使用目标最大概率估计的研究
Yaning Feng1,2, Kenneth Chi-Yin Wong2, Perry Bok-Man Leung3,4
1School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China.
Psychological medicine
|April 28, 2025
概括
第二代抗精神病药物 (SGA) 影响代谢健康,对BMI和甘油三的影响随着时间的推移显示了反转的U形. 一些副作用,特别是在BMI上,可能会在停止SGA后持续存在,克洛扎平和奥兰扎平带来更高的风险.
科学领域:
- 药物监督 药物监督 药物监督
- 代谢健康 代谢健康
- 精神分裂症治疗 治疗精神分裂症
背景情况:
- 第二代抗精神病药物 (SGA) 与代谢副作用有关.
- 时间不变和时间变化的混因素使这些影响的评估变得复杂.
- 有限的现实世界数据存在于不同SGA治疗序列的长期,动态代谢影响.
研究的目的:
- 评估SGA在现实世界队列中的长期,动态代谢影响.
- 评估治疗时间和治疗顺序对代谢结果的影响.
- 确定具有较高代谢风险的特定SGA.
主要方法:
- 对696名患有精神分裂症谱系障碍的中国患者进行了自然主义队列的跟踪.
- 使用纵向目标最大概率估计 (LTMLE) 来估计平均治疗效应 (ATE).
- 代谢结果 (TC,HDL,LDL,TG,FG,BMI) 在6-18个月的3个月间隔进行评估,考虑到混因素.
主要成果:
- 持续的SGA治疗对BMI和TG (达到12个月的峰值) 以及TC和LDL (达到15个月的峰值) 产生了反转的U形效应.
- 禁食葡萄糖和HDL在6个月左右达到峰值.
- 与其他代谢参数不同的是,BMI的不良影响在停药后持续存在. 克洛沙平和奥兰沙平表现出更大的代谢副作用.
结论:
- 随着长时间的连续治疗,SGA的代谢副作用可能会稳定.
- 克洛扎和奥兰扎与更高的心脏代谢风险有关.
- 在停止SGA治疗后持续的BMI变化凸显了需要仔细监测和管理的需要.
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