Abstract
Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design. This study aims to explore the response trajectory of antipsychotics and compare the treatment responses of seven different antipsychotics over 6 weeks in patients with schizoprenia (trial registration: Chinese Clinical Trials Registry Identifier: ChiCTR-TRC-10000934). Data were collected from a multicentre, randomised open-label clinical trial. Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up at weeks 2, 4 and 6. Trajectory groups were classified by the method of k-means cluster modelling for longitudinal data. Trajectory analyses were also employed for the seven antipsychotic groups. The early treatment response trajectories were classified into a high-trajectory group of better responders and a low-trajectory group of worse responders. The results of trajectory analysis showed differences compared with the classification method characterised by a 50% reduction in PANSS scores at week 6. A total of 349 patients were inconsistently grouped by the two methods, with a significant difference in the composition ratio of treatment response groups using these two methods (χ2 = 43.37, P < 0.001). There was no differential contribution of high- and low trajectories to different drugs (χ2 = 12.52, P = 0.051); olanzapine and risperidone, which had a larger proportion in the >50% reduction at week 6, performed better than aripiprazole, quetiapine, ziprasidone and perphenazine. The trajectory analysis of treatment response to schizophrenia revealed two distinct trajectories. Comparing the treatment responses to different antipsychotics through longitudinal analysis may offer a new perspective for evaluating antipsychotics.
Highlights
Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design
The early treatment response trajectories were classified into a high-trajectory group of better responders and a low-trajectory group of worse responders
The results of trajectory analysis showed differences compared with the classification method characterised by a 50% reduction in Positive and Negative Syndrome Scale (PANSS) scores at week 6
Summary
Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design. A meta-analysis of the time course of treatment response reported an early response profile for antipsychotic treatment.[1] previous studies have shown that the treatment response to schizophrenia is heterogeneous. Most patients’ symptoms improve after treatment, approximately a third of patients respond poorly and are considered to be drug resistant.[2,3] Some studies have even found that the drugs available to treat schizophrenia are only effective in approximately 50% of patients.[4] A poor response to treatment may lead to worse community functioning,[5] symptom exacerbation,[6] relapse,[7] reduced patient adherence,[8] increased risk of admission to hospital, and heavy social and economic burden.[9] In particular, in the early stages of treatment with antipsychotic drugs, symptom improvement is not stable; longitudinal profiles of the early efficacy of different antipsychotics can provide novel insight into their different characteristics
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