Adrianzén C, Dossenbach M, Leadbetter M

Idioma: Español
Referencias bibliográficas: 52
Paginas: 86-94
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RESUMEN

Objetivo: evaluar los resultados de salud y los costos relacionados de los medicamentos antipsicóticos disponibles, haciendo énfasis en olanzapina, en ambientes naturalísticos de atención ambulatoria. Métodos: 572 pacientes con esquizofrenia (CIE-10 ó DSM-IV) quienes iniciaron o cambiaron a una medicación antipsicótica oral fueron enrolados en bloques de 10 pacientes: 5 para olanzapina y 5 para otro antipsicótico diferente de olanzapina de acuerdo a la prescripción de ese momento. La efectividad se midió a través del cambio promedio en el puntaje de la escala de Impresión Clínica Global de Severidad de la enfermedad (ICG-S). “Respuesta clínica” fue definida como la disminución ≥ 2 puntos en la ICG-S si el basal fue ≥ 4 y disminución ≥ 1 si el basal fue ≤ 3. “Mínimamente sintomático” se definió al hecho de alcanzar un puntaje de 1 ó 2 en la ICG-S luego del basal. Se registraron los eventos adversos emergentes del tratamiento, el uso de medicación concomitante y las causas de abandono de la medicación. Resultados: el SOHO-Región Andina enroló 272, 97 y 65 pacientes en monoterapia con olanzapina, antipsicóticos típicos (AT) y risperidona respectivamente. Tanto, olanzapina como risperidona fueron más efectivos que los AT en mejorar los síntomas generales, positivos y negativos a los 12, 24 y 36 meses, pero sólo olanzapina mostró diferencia significativa vs AT en mejorar los síntomas depresivos y cognitivos. Menos pacientes en olanzapina presentaron SEP y eventos adversos sexuales. Los pacientes en olanzapina presentaron la menor tasa de disquinesia tardía a los 3 años. Más pacientes en olanzapina ganaron peso con una diferencia estadística significativa vs risperidona y AT. La ganancia promedio de peso con olanzapina fue 5 kilos y el mayor incremento se registró en los primeros 12 meses de tratamiento. Conclusiones: olanzapina, fue más efectiva que los AT en mejorar los síntomas depresivos y cognitivos con diferencia estadística, no así risperidona. Olanzapina fue mejor tolerada en términos de SEP, disquinesia tardía y compromiso de la función sexual. Se registró mayor ganancia de peso con olanzapina; sin embargo, la tasa de abandono por intolerabilidad fue menor. Estos resultados apoyan los mayores beneficios de los atípicos en términos de efectividad y tolerabilidad.

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