Fréquence et modalités de relais vers un traitement antipsychotique à action prolongée injectable : analyse des données du registre Exprime

RésuméL’objectif de cette enquête pharmaco-épidémiologique observationnelle était d’évaluer la fréquence d’un relais vers un traitement injectable d’action prolongée chez des patients psychotiques. Les données ont été colligées à partir des 30 premiers patients par 589 psychiatres. Cinq mille sept cent dix-neuf patients d’âge moyen de 38,6 ans, dont 58,9 % d’hommes, ont été inclus. Les patients souffrant de troubles schizophréniques étaient de 72,6 % (dont 53,6 % paranoïdes) avec une durée moyenne d’évolution de 12,2 ans. Environ 94,9 % avaient une monothérapie antipsychotique (dont 53,1 % atypiques), mais d’autres classes médicamenteuses étaient associées pour 76,5 % des patients. À l’issue de la consultation, 29 % ont basculé d’une voie orale à une voie intramusculaire, et globalement 34,6 % des patients ont eu un traitement injectable, avec une réduction des coprescriptions. Ces résultats témoignent de l’intérêt apporté à une administration favorisant l’observance.

ObjectiveAlthough the nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for psychotic disorders and schizophrenia, the aim of our survey was to evaluate the switching frequency to a long-acting injectable antipsychotic treatment in patients with psychotic disorders followed by specialized psychiatric consultations.MethodsAn observational epidemiological survey including 589 psychiatrists based on a medical consultation register of where, for the maximum of the first 30 patients. Age, gender, diagnosis of psychosis (according to ICD-10 classification), antipsychotic and psychotropic treatments prescribed prior and after the consultations as well as administration route were collected.ResultsFive thousand seven hundred and nineteen patients with the mean age of 38.6 and the gender ratio of 41.1% female/58.9% male were included in the register. The mean duration of psychosis was 12.2 years (± 9.9). Patients suffering from schizophrenia disorder were 72.6% with a predominance of paranoid type (53.6%). At the consultation, 94.9% patients were taking an antipsychotic monotherapy. Conventional neuroleptics and atypical antipsychotics were taken by 46.5% and 53.1% patients, respectively. Only 76.5% patients received a concomitant psychotropic medication, mostly benzodiazepines and sedative phenothiazin. The percentage of patients treated with long acting injectable antipsychotics (intramuscular injection) increased from 17.8 to 34.7% at the end of the consultation. Approximately 28.5% patients switched from the oral route to the injectable route (IM) and the percentage of concomitant psychotropic medication decreased from 76.5 to 69.1% at the end of the consultation. The major reasons advanced by psychiatrist to switch to a long acting injectable antipsychotic were mostly a relapse prevention with a better efficacity on all the symptoms, and a better adherence to the antipsychotic medication regimen.ConclusionThis epidemiological assessment on the treatment relay modalities in patients with psychosis showed the new interest in the long-acting injectable antipsychotic medications in management of psychosis and in a better global outcome.