Relationship between efficacy and common metabolic parameters in first-treatment drug-naïve patients with early non-response schizophrenia: a retrospective study

Abstract

Background Comorbid metabolic disorders in patients with schizophrenia are very common. Patients with schizophrenia who respond to therapy early are often strongly predictive of better treatment outcomes. However, the differences in short-term metabolic markers between early responders and early non-responders in schizophrenia are unclear. Methods 143 first-treatment drug-naïve schizophrenia patients were included in this study and were given a single antipsychotic medication for 6 weeks after admission. After 2 weeks, the sample was divided into an early response group and an early non-response group based on psychopathological changes. For the study endpoints, we depicted the change curves of psychopathology in both subgroups and compared the differences between the two groups in terms of remission rates and multiple metabolic parameters. Results The early non-response had 73 cases (51.05%) in the 2nd week. In the 6th week, the remission rate was significantly higher in the early response group than in the early non-response group (30,42.86% vs. 8,10.96%); the body weight, body mass index, blood creatinine, blood uric acid, total cholesterol, triglyceride, low-density lipoprotein, fasting blood glucose, and prolactin of the enrolled samples were significantly increased, and high-density lipoprotein was significantly decreased. ANOVAs revealed a significant effect of treatment time on abdominal circumference, blood uric acid, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, fasting blood glucose and prolactin, and a significant negative effect of early non-response to treatment on abdominal circumference, blood creatinine, triglyceride, fasting blood glucose. Conclusions Schizophrenia patients with early non-response had lower rates of short-term remission and more extensive and severe abnormal metabolic indicators. In clinical practice, patients with early non-response should be given a targeted management strategy, antipsychotic drugs should be switched on time, and active and effective interventions for their metabolic disorders should be given.

Incidence and factors associated of early non-response in first-treatment and drug-naïve patients with schizophrenia: a real-world study

“…The contradictory results may stem from strict restrictions on prescribed medications and enrollment criteria. Furthermore, research has indicated that metabolic disturbances, such as BW ( 19 ) and FBG ( 10 ), are more severe in treatment non-responders even before antipsychotics are prescribed. In light of our findings, it is reasonable to assert that FTDN schizophrenia patients with poor treatment response not only suffer from more severe psychiatric symptoms but also experience more pronounced metabolic disturbances.…”

“…In summary, whatever the assessment tool used and whatever the time cut-off point, any effective separation of early non-responders from the patient population is to be acknowledged. A realistic implication of this is to implement targeted clinical management measures as soon as possible to improve the prognosis and adverse effects in this subgroup of patients ( 10 ).…”

“…Early response to treatment in schizophrenia is of great significance for better management of the disorder in the future and is touted as one of the most reliable predictors of long-term clinical outcome in schizophrenia ( 6 ). Poor early response or early non-response to treatment often strongly indicates non-response to subsequent treatment ( 7 , 8 ), higher discontinuation rates ( 9 ), more severe metabolic disorder adverse reactions ( 10 ), etc. A previous review of diagnostic tests concluded that no/minimal response to antipsychotics within the first 2 weeks of treatment may be a sufficient indication for switching antipsychotics ( 11 ), rather than the 4–8 weeks of acute phase drug titration and adequate time for observation traditionally recommended by treatment guidelines ( 9 ).…”