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作者：Pam Harrison  
出處：WebMD醫學新聞

　　March 10, 2010（喬治亞州沙瓦納）－根據一項於美國老年精神學學會2010年會中發表的發現，抗精神異常藥物quetiapine（Seroquel，阿斯特捷利康藥廠）與開始治療前無代謝異常老年病患更早發生代謝異常有關。
　　
　　加拿大魁北克蒙特婁大學Genevieve Letourneau醫師與同事們發現，接受quetiapine治療17.5個月的病患，相較於接受olanzapine治療32.6個月、或是risperidone治療36.3個月的病患，發生高血糖所需時間顯著較短。然而，隨著時間，高血糖的盛行率在三組之間並無太大變化。
　　
　　發生高膽固醇血症所需時間，以及病患變成膽固醇過高的可能性，接受quetiapine治療15.8個月病患，同樣高於接受olanzapine治療27.4個月與risperidone治療21.9個月。
　　
　　相較於接受olanzapine治療21.4個月或risperidone治療25個月，接受quetiapine治療20.9個月發生高三酸甘油酯所需時間較短，且盛行率也較高。
　　
　　Letourneau醫師向Medscape精神學表示，這是項寫實的研究，所以病患們沒有被隨機分派，他們接受醫師認為對他們將會是最好的治療。
　　
　　她附帶表示，但是我們相信代謝風險較高的病患比較可能使用到quetiapine，因為一般認知quetiapine是個較安全的藥物，所以這可能解釋了這些病患較快發生代謝異常的原因。
　　
　　【不同疾患】
　　在這項研究中，研究者們追蹤231位使用這三種抗精神分裂藥物治療不同疾病的患者，包括憂鬱症、雙極性躁鬱症或是失智。這些病患都超過70歲，且都接受至少6個月的治療，追蹤最長達40個月。
　　
　　第1年時，每3個月追蹤1次空腹血糖、血脂肪、生物計量數據，例如體重與腰圍，之後每2年追蹤1次。
　　
　　在治療前就有血脂肪異常或葡萄糖耐受性不佳的患者被排除在研究之外，大部分病患使用這三種藥物的標準劑量。
　　
　　整體來說，研究者們發現50%以上病患在後續追蹤結束時，有三種代謝異常的其中一種。
　　
　　Letourneau醫師表示，這些是初期研究數據，我們開始進一步針對相關數據與使用劑量進行分析。但是我們真的對這些結果感到驚訝，因為我們並未預期quetiapine與最快發生高血糖有關，結果顯示，這些老年病患在年輕就應該更認真地注意代謝異常的問題，且醫師們在開始抗精神分裂治療前，必須與病患討論發生代謝異常的可能性。
　　
　　賓州匹茲堡大學醫學中心的Ellen Whyte醫師表示，這項研究指出，臨床醫師在處方藥物時必須要謹慎。
　　
　　她向Medscape精神醫學表示，某些病患仍將需要抗精神分裂藥物，而老年病患顯然無法免於這些藥物的代謝副作用，因此，我們需要繼續監測這些副作用，且以停藥或是儘可能使用最低有效劑量來處理，並明智地與初級照護醫師共同處理相關內科疾病。
　　
　　Letourneau醫師與Whyte醫師表示已無相關資金上的往來。


Quetiapine Linked to More Rapid Onset of Metabolic Disturbances in Elderly Patients

By Pam Harrison
Medscape Medical News

March 10, 2010 (Savannah, Georgia) — The antipsychotic quetiapine (Seroquel, AstraZeneca) is associated with a more rapid onset of metabolic disturbances than other antipsychotics in elderly patients with no baseline metabolic abnormalities before treatment initiation, according to findings presented here at the American Association for Geriatric Psychiatry 2010 Annual Meeting.

Genevieve Letourneau, MD, University of Montreal, Quebec, Canada, and colleagues found that time to onset of hyperglycemia was significantly shorter among patients treated with quetiapine at 17.5 months compared with patients who were treated with olanzapine at 32.6 months or risperidone at 36.3 months. However, the prevalence of hyperglycemia was the same in all 3 groups over time.

Time to onset of hypercholesterolemia was also shorter and the likelihood of patients becoming hypercholesterolemic higher among those treated with quetiapine at 15.8 months compared with olanzapine at 27.4 months and risperidone at 21.9 months.

Quetiapine was similarly associated with a shorter time to onset and a higher prevalence of hypertriglyceridemia at 20.9 months compared with olanzapine at 21.4 months or risperidone at 25 months.

"This is a naturalistic study, so patients were not randomized; they were given what their physician thought would be best for them," Dr. Letourneau told Medscape Psychiatry.

"But we believe that patients with a higher metabolic risk profile were more likely to be put on quetiapine because there is this general idea that quetiapine is a ‘safer’ drug, so this might explain the faster onset of metabolic disorders in these patients," she added.

Various Illnesses

For the study, investigators followed up 231 outpatients treated with 1 of the 3 antipsychotics for various illnesses, including psychosis, depression, bipolar disorders, or dementia. All patients were 70 years or older, and all had been treated for a minimum of 6 months and were followed up for a maximum of 40 months.

Fasting glucose, lipids, and biometric data, such as weight and abdominal circumference, were monitored every 3 months during the first year of treatment and biannually thereafter.

Patients who had evidence of dyslipidemia or glucose intolerance before the initiation of therapy were excluded from the study. Most patients were taking standard doses of each of the 3 medications.

Overall, investigators found that more than 50% of the study group developed 1 of the 3 metabolic abnormalities by the end of follow-up.

"These are preliminary results, and we are starting to look at the data and the dosages used more closely," said Dr. Letourneau. "But we were really surprised by these results because we were not expecting quetiapine to be associated with the fastest onset of hyperglycemia, and this just shows that metabolic abnormalities have to be taken as seriously in older patients as they are in younger patients and that physicians must discuss the possibility of patients developing metabolic abnormalities before initiating antipsychotic therapy."

Ellen Whyte, MD, University of Pittsburgh Medical Center, Pennsylvania, said the study points to the fact that physicians have to be cautious about the medications they prescribe.

"Some patients still require an antipsychotic medication," she told Medscape Psychiatry, "but the elderly are obviously not protected from the metabolic side effects of these drugs, and we need to continue to monitor patients for these side effects and then manage them either by discontinuing the drug, if possible, or using the lowest possible dose and then managing the medical illness judiciously in conjunction with the primary doctor."

Dr. Letourneau and Dr. Whyte have disclosed no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2010 Annual Meeting: Abstract NR 20. Presented March 6, 2010.