Stellenwert von Depotformulierungen in der Langzeittherapie der Schizophrenie

Zusammenfassung

Die Verhinderung eines Rezidivs ist das zentrale Therapieziel in der Behandlung der Schizophrenie. Jedoch erleiden schätzungsweise 75 % aller Schizophreniepatienten innerhalb von fünf Jahren ein Rezidiv. Jedes Rezidiv kann das Krankheitsbild verschlechtern und das Risiko für psychosoziale und berufliche Nachteile erhöhen. Eine kontinuierliche und langfristige Behandlung kann dieses Risiko deutlich verringern. Limitierender Faktor einer kontinuierlichen Langzeittherapie ist allerdings die Medikamenten-Adhärenz, die durch zahlreiche Faktoren beeinflusst wird. Naturalistische Studien haben gezeigt, dass Depot-Antipsychotika im Vergleich zur oralen Medikation konsistent ein besseres Outcome aufweisen, z. B. in Form einer reduzierten Rezidivrate und des Rückgangs stationärer Aufenthalte. Auch zahlreiche Metaanalysen von randomisierten kontrollierten Vergleichsstudien von Depot-Antipsychotika vs. orale Formulierungen zeigen diese Vorteile, jedoch sind die Ergebnisse nicht in allen Metaanalysen konsistent. Ergebnisse aus kontrollierten Studien spiegeln die Gegebenheiten der täglichen Praxis nicht adäquat wider. In naturalistischen Studien zeigen sich die Vorteile von Depot-Antipsychotika deutlicher. Die vorliegende Übersicht reflektiert die derzeitige Schizophrenie-Behandlung und diskutiert einen breiteren Einsatz von Depot-Antipsychotika anhand der verfügbaren Daten. Zudem werden Befürchtungen und Vorurteile von Arzt und Patient bezüglich Antipsychotika-Langzeittherapie mit Depotformulierungen erörtert und Empfehlungen für die Praxis ausgesprochen.

Abstract

Relapse prevention in schizophrenia is a key aim in therapy. However, it is estimated that approximately 75 % of patients with schizophrenia relapse within five years. Each relapse might worsen the disease and increase the risk of psychosocial and work-related disadvantages. A continuous long-term therapy is able to reduce this risk, but medical non-adherence, which is influenced by numerous factors, is a limitation. Naturalistic studies show that depot-antipsychotics compared with oral antipsychotics lead consistently to a better outcome, for example by reducing relapse rates or hospitalisation. Numerous meta-analyses of randomised controlled trials comparing oral versus depot-antipsychotics also show this advantages. However these results are not consistent in all meta-analyses. Results of controlled studies do not appropriately reflect the reality of daily practice. The advantages of depot-antipsychotics are shown more distinctly in naturalistic studies. The following review reflects the current therapy of schizophrenia and discusses adequately a broad application of depot-antipsychotics based on existing data. In addition, concerns and prejudices of physicians and patients against antipsychotic long-term therapy and depot-formulation are discussed and a recommendation is provided.

Schlüsselwörter

Schizophrenie - Rezidiv - Langzeittherapie - Medikamenten-Adhärenz - Depot-Antipsychotika

Key words

schizophrenia - relapse - longterm therapy - adherence - long acting injectable antipsychotics

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