Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial

作者全名："Long, Yujun; Wu, Qiongqiong; Yang, Ye; Cai, Jingda; Xiao, Jingmei; Liu, Zhaoqian; Xu, Yifeng; Chen, Ying; Huang, Manli; Zhang, Ruiguo; Xu, Xijia; Hu, Jian; Liu, Zhifen; Liu, Fang; Zheng, Yingjun; Meng, Huaqing; Wang, Zhimin; Tang, Yanqing; Song, Xueqin; Chen, Yunchun; Wang, Xueyi; Liu, Tiebang; Wu, Xiaoli; Fang, Maosheng; Wan, Chunling; Zhao, Jingping; Wu, Renrong"

作者地址："[Long, Yujun; Wu, Qiongqiong; Yang, Ye; Cai, Jingda; Xiao, Jingmei; Zhao, Jingping; Wu, Renrong] Cent South Univ, Xiangya Hosp 2, Natl Clin Res Ctr Mental Disorders, Dept Psychiat, 139 Renmin Middle RD, Changsha 410011, Hunan, Peoples R China; [Long, Yujun; Wu, Qiongqiong; Yang, Ye; Cai, Jingda; Xiao, Jingmei; Zhao, Jingping; Wu, Renrong] Cent South Univ, Natl Ctr Mental Disorders, Xiangya Hosp 2, 139 Renmin Middle RD, Changsha 410011, Hunan, Peoples R China; [Liu, Zhaoqian] Cent South Univ, Xiangya Hosp, Dept Clin Pharmacol, Changsha, Hunan, Peoples R China; [Xu, Yifeng] Shanghai Jiao Tong Univ, Shanghai Mental Hlth Ctr, Dept Psychiat, Sch Med, Shanghai, Peoples R China; [Chen, Ying] Sichuan Univ, Huaxi MR Res Ctr HMRRC, Dept Radiol, West China Hosp, Chengdu, Sichuan, Peoples R China; [Huang, Manli] Zhejiang Univ, Affiliated Hosp 1, Dept Psychiat, Sch Med, Hangzhou, Zhejiang, Peoples R China; [Zhang, Ruiguo] AF Mil Med Univ, Xijing Hosp, Dept Psychiat, Xian, Shaanxi, Peoples R China; [Xu, Xijia] Nanjing Med Univ, Nanjing Brain Hosp, Dept Psychiat, Affiliated Brain Hosp, Nanjing, Jiangsu, Peoples R China; [Hu, Jian] Harbin Med Univ, Affiliated Hosp 1, Dept Psychiat, Harbin, Heilongjiang, Peoples R China; [Liu, Zhifen] Shanxi Med Univ, Hosp 1, Dept Psychiat, Taiyuan, Shanxi, Peoples R China; [Liu, Fang] Kunming Med Univ, Affiliated Hosp 1, Dept Psychiat, Kunming, Yunnan, Peoples R China; Guangzhou Med Univ, Affiliated Brain Hosp, Dept Psychiat, Guangzhou, Guangdong, Peoples R China; Chongqing Med Univ, Affiliated Hosp 1, Dept Psychiat, Chongqing, Peoples R China; Capital Med Univ, Beijing Anding Hosp, Natl Clin Res Ctr Mental Disorders, Beijing, Peoples R China; China Med Univ, Hosp 1, Dept Psychiat, Shenyang, Liaoning, Peoples R China; Zhengzhou Univ, Affiliated Hosp 1, Dept Psychiat, Zhengzhou, Henan, Peoples R China; Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Psychiat, Xian, Shaanxi, Peoples R China; Hebei Med Univ, Hosp 1, Dept Psychiat, Shijiazhuang, Hebei, Peoples R China; Shenzhen Kangning Hosp, Dept Psychiat, Shenzhen, Guangdong, Peoples R China; Sun Yat Sen Univ, Affiliated Hosp 3, Dept Psychiat, Guangzhou, Guangdong, Peoples R China; Wuhan Mental Hlth Ctr, Wuhan, Hubei, Peoples R China; Shanghai Jiao Tong Univ, BioX Inst, Key Lab Genet Dev & Neuropsychiat Disorders, Minist Educ, Shanghai, Peoples R China"

通信作者："Wu, RR (通讯作者)，Cent South Univ, Xiangya Hosp 2, Natl Clin Res Ctr Mental Disorders, Dept Psychiat, 139 Renmin Middle RD, Changsha 410011, Hunan, Peoples R China.; Wu, RR (通讯作者)，Cent South Univ, Natl Ctr Mental Disorders, Xiangya Hosp 2, 139 Renmin Middle RD, Changsha 410011, Hunan, Peoples R China."

来源：BMC MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001032094700004

JCR分区：Q1

影响因子：7

年份：2023

卷号：21

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Schizophrenia; Early response; Atypical antipsychotic; Prediction

摘要："BackgroundIt remains a challenge to predict the long-term response to antipsychotics in patients with schizophrenia who do not respond at an early stage. This study aimed to investigate the optimal predictive cut-off value for early non-response that would better predict later non-response to antipsychotics in patients with schizophrenia.MethodsThis multicenter, 8-week, open-label, randomized trial was conducted at 19 psychiatric centers throughout China. All enrolled participants were assigned to olanzapine, risperidone, amisulpride, or aripiprazole monotherapy for 8 weeks. The positive and negative syndrome scale (PANSS) was evaluated at baseline, week 2, week 4, and week 8. The main outcome was the prediction of nonresponse. Nonresponse is defined as a < 20% reduction in the total scores of PANSS from baseline to endpoint. Severity ratings of mild, moderate, and severe illness corresponded to baseline PANSS total scores of 58, 75, and 95, respectively.ResultsAt week 2, a reduction of < 5% in the PANSS total score showed the highest total accuracy in the severe and mild schizophrenia patients (total accuracy, 75.0% and 80.8%, respectively), and patients who were treated with the risperidone and amisulpride groups (total accuracy, 82.4%, and 78.2%, respectively). A 10% decrease exhibited the best overall accuracy in the moderate schizophrenia patients (total accuracy, 84.0%), olanzapine (total accuracy, 79.2%), and aripiprazole group (total accuracy, 77.4%). At week 4, the best predictive cut-off value was < 20%, regardless of the antipsychotic or severity of illness (total accuracy ranging from 89.8 to 92.1%).ConclusionsSymptom reduction at week 2 has acceptable discrimination in predicting later non-response to antipsychotics in schizophrenia, and a more accurate predictive cut-off value should be determined according to the medication regimen and baseline illness severity. The response to treatment during the next 2 weeks after week 2 could be further assessed to determine whether there is a need to change antipsychotic medication during the first four weeks."

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