阿尔茨海默病患者不宜过早停用利培酮

根据《新英格兰医学杂志》上发表的一项研究结果，对于发生精神病或躁动-攻击并对利培酮治疗有应答的阿尔茨海默病(AD)患者，依照建议在3~6个月后停药与复发率加倍相关。(N. Engl. J. Med. 2012 [doi:10.1056/NEJMoa1114058])

D. P. Devanand博士

纽约市哥伦比亚大学纽约州精神病学研究所的D.P. Devanand博士指出，出于对不良反应的顾虑，“尽管缺乏高质量的支持证据，针对护理机构的联邦法规仍然强烈要求在治疗3~6个月后停用抗精神病药物”。

Devanand博士及其同事在7月份的阿尔茨海默病国际会议上展示了他们的研究结果。“我们的研究结果提示，对抗精神病药物治疗4~8个月有稳定应答的精神病或躁动-攻击患者，停药4个月以后的复发风险显著增高。应当在这一结果与继续抗精神病药物治疗的不良反应风险之间进行权衡。”研究者总结认为，对于有精神病或躁动-攻击的AD患者，不宜急于停用抗精神病药物治疗。

这项研究是由国立卫生研究院和美国退伍军人事务部资助的。Devanand博士及其同时报告与企业资源之间存在多种利益关系。

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By: MARY ANN MOON, Internal Medicine News Digital Network

Among patients with Alzheimer’s disease who develop psychosis or agitation-aggression that responds to risperidone, discontinuing the drug as advised after 3-6 months is associated with a doubling of the rate of relapse, according to a study published Oct. 17 in the New England Journal of Medicine.

"Federal regulations for nursing homes strongly urge discontinuation of antipsychotic drugs after 3-6 months of treatment" because of concern about adverse effects, even though "evidence from controlled trials in support of this long-standing regulation is very limited," said Dr. D.P. Devanand of the New York State Psychiatric Institute and Columbia University, New York, and his associates.

"Our findings suggest that patients with psychosis or agitation-aggression who have a sustained response to antipsychotic treatment for 4-8 months have a significantly increased risk of relapse for at least 4 months after discontinuation, and this finding should be weighed against the risk of adverse effects with continued antipsychotic treatment," they noted (N. Engl. J. Med. 2012 [doi:10.1056/NEJMoa1114058]).

Dr. Devanand and his colleagues presented their findings in July at the Alzheimer’s Association International Conference; read our coverage here.

This study was funded by the National Institutes of Health and the U.S. Department of Veterans Affairs. Dr. Devanand and his associates reported numerous ties to industry sources.