| 摘要: | 研究背景：精神科病人中高復發風險族群已有長效抗精神病藥物針劑可使用，以減少因藥品依從性差病患的疾病復發率，但長效針劑有價格高昂、注射部位副作用等缺點。台灣核准lurasidone於2017年上市，適應症為思覺失調症、第一型雙極性疾患鬱症，藥理作用有較低副作用 (鎮靜、食慾與體重上升、代謝症候群等)。研究目的：探討lurasidone於真實世界中處方型態以及服藥依從性。研究方法：收錄2021年11月20日至2022年2月20日於林口長庚醫院曾使用lurasidone之病患，追溯病患首次開立lurasidone之日期訂為指標日期 (index date)，並持續追蹤指標日期 +365天。利用抗精神病藥物轉換網站計算其他藥物轉換至lurasidone的等效劑量，並與醫師開立lurasidone劑量相除取得轉換劑量差異比值。分析停用lurasidone人數與持續使用lurasidone日數表達用藥持續性；並計算MPR (medication possession rate , %)，定義MPR 0.8以推論病患有良好的用藥依從性。研究結果：本研究收錄思覺失調症組共31人、雙極性疾患組共37人、憂鬱症組共21人、其他組共11人。Lurasidone服用最高劑量平均數分別為: 思覺失調症族群95.5mg、雙極性疾患族群64.3mg、憂鬱症族群45.7mg。調至lurasidone服用最高劑量日數平均數由低至高分別為: 思覺失調症族群48.4天、憂鬱症族群74.3天、雙極性疾患族群94.8天。由ziprasidone轉換至lurasidone為所收錄轉換用藥之抗精神病藥物類別中最多占20.4%，醫師處方ziprasidone轉換劑量與文獻提供轉換劑量差異平均值為0.79，其中思覺失調症原接受ziprasidone 60mg者起始轉換劑量多為lurasidone 40mg；差異平均值最高者為7.91，是由quetiapine轉換至lurasidone。此外，各組病人停用lurasidone人數百分比分別為雙極性疾患族群21.2%、思覺失調症族群26.7%、憂鬱症族群37.5%；持續使用lurasidone日數平均數由高至低分別為: 雙極性疾患族群315.8天、思覺失調症族群307.3天、憂鬱症族群287.6天；各族群MPR百分比平均數皆高於95%，各族群超過九成病人其MPR 0.8。用藥依從性高者也有較高比例病患使用多重精神病藥物。結論：本研究所收錄百位lurasidone於真實世界處方型態在醫學中心初探結果，顯示精神科不同診斷病人皆有開立使用，其中思覺失調症族群轉換後開立lurasidone劑量平均數最高且調至最高劑量所需時間最短；原使用ziprasidone病人經醫師處方轉換至lurasidone之轉換劑量差異平均值最小。轉換藥物時仍需考量處方組合、臨床治療症狀及抗精神病藥物潛在交互作用。思覺失調症、雙極性疾患、憂鬱症族群有良好的用藥依從性。未來可續探討含lurasidone多重抗精神病藥物劑量組合及副作用改善情形，以利處方型態優化。
Background: Long-acting antipsychotic injections are available for psychiatric patients in high-relapse-risk groups. They can reduce relapse rates in patients with poor drug compliance, but long-acting injections have drawbacks such as high prices and side effects at the injection site. Approved in Taiwan, lurasidone was launched in 2017 and is indicated for schizophrenia and type 1 bipolar depression. It has lower side effects (sedation, increased appetite and weight, metabolic syndrome, etc.). Purpose: Exploring prescription patterns and medication adherence in psychiatric disorder patients switched to lurasidone. Methods: Patients who had used lurasidone at Linkou Chang Gung Hospital from November 20, 2021 to February 20, 2022 were enrolled, the date of the first prescription of lurasidone was set as the index date, and the index date was tracked for +365 days. The antipsychotic switching website was used to calculate the equivalent dose of other drugs switched to lurasidone, and the ratio was obtained by dividing the dose prescribed by the physician. The number of lurasidone discontinuers and the number of days of lurasidone use were used to express medication persistence; and MPR was calculated and defined as MPR 0.8 to infer good medication adherence. Results: The study included 31 participants in the schizophrenia group, 37 in the bipolar disorder group, 21 in the depression group, and 11 in the other group. The mean of the highest prescribed dose of lurasidone was 95.5mg in the schizophrenia group, 64.3mg in the bipolar disorder group, and 45.7mg in the depression group. The mean number of days since the highest dosage was reached was 48.4 days in the schizophrenia group, 74.3 days in the depression group, and 94.8 days in the bipolar disorder group. Conversion from ziprasidone to lurasidone accounted for 20.4% of the total antipsychotic drug classes with the highest number of conversions recorded, and the mean ratio between the physician-prescribed ziprasidone switching dose and the switching dose provided in the literature was 0.79, patients who originally received ziprasidone 60 mg for schizophrenia having a greater number of conversions to lurasidone 40 mg; the highest mean ratio of 7.91 was for conversion from quetiapine to lurasidone. The percentage of lurasidone discontinuation was 21.2% in the bipolar disorder group, 26.7% in the schizophrenia group, 37.5% in the depression group. The average duration of lurasidone use was 315.8 days for the bipolar group, 307.3 days for the schizophrenia group, and 287.6 days for the depression group. The mean percentage of MPR was above 95% for all ethnic groups, and over 90% of patients in all ethnic groups had an MPR of 0.8. Higher percentages of patients with high medication adherence were also found to be using multiple psychotropic medications. Conclusions: The results of a preliminary study of 100 real-world lurasidone prescribing patterns in a medical center showed that lurasidone was prescribed to patients with different diagnoses in psychiatry, the highest mean dose of lurasidone prescribed after conversion and the shortest time to reach the highest dose were found in the schizophrenia group. The mean ratio between the physician-prescribed ziprasidone switching dose and the switching dose provided in the literature was the smallest of all antipsychotics classes. Prescription combinations, clinical symptoms and potential antipsychotic interactions still need to be considered when switching medications. Good drug adherence has been observed in schizophrenia, bipolar disorder and depression groups. In the future, the dosage combination of lurasidone-containing multiple antipsychotics and the improvement of side effects can be further explored to facilitate the optimization of the prescription pattern. |
