섬망 치료에서 Aripiprazole과 Quetiapine의 효과와 안정성에 대한 비교 연구

Comparative Study of Efficacy and Safety between Aripiprazole and Quetiapine in the Treatment of Delirium

본 연구는 섬망 치료에 있어 aripiprazole과 quetiapine의 치료 효과와 안정성을 비교 평가하였다. 42명의 섬망환자에게 aripiprazole과 quetiapine을 무작위배정하여, 관해시점까지 투약하였다. 섬망의 중등도를 평가하기 위해, KDRS-98과 CGI-S를 사용하였고, 진정 작용은 RASS를 통해 측정하였다. 또한 부작용은 DIEPSS와 BARS 및 환자의 주관적 보고를 통해 평가하였다. 본 연구 결과 섬망의 치료에 있어서 aripiprazole군과 quetiapine군 모두에서 KDRS-98 및 CGI-S의 점수가 감소하였고, 두 군 간의 점수 차이는 없었다. 또한 관해기간에서 두 군 간의 유의한 차이를 보이지 않았다. 섬망의 증상 중 수면 문제에 있어서는 quetiapine이 aripiprazole에 비해 더 효과적이었고, aripiprazole이 섬망 환자에서 quetiapine보다 진정 작용이 덜 하였다. 두 군 모두에서 심각한 부작용 없이 섬망에서 호전되었고, 추체외로증상에 있어서도 유의한 차이가 없었다. 이러한 결과는 두 약물 모두가 섬망의 치료에 있어 안전하고 효과적인 치료제임을 의미한다. 본 연구 결과는 섬망의 치료에서 두 약물간의 임상적 효과 차이를 통해, 섬망의 임상 양상의 차이에 따른 치료 전략을 제시할 수 있다는 가능성을 보여준다. 이 결과를 입증하기 위해서는 향후 대규모 환자를 대상으로 한 장기간의 이중맹검 연구가 필요할 것이다.

Objective Haloperidol, a typical antipsychotic, has been the preferred agent for the pharmacological treatment of delirium. Recent studies have shown that atypical antipsychotics can be as effective as haloperidol in managing delirium. However, there are few comparative studies between atypical antipsychotics in the treatment of delirium. We investigated the efficacy and side effects of aripiprazole and quetiapine for the treatment of patients with delirium. Methods Forty two inpatients with delirium according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Text Revision and Korean version of Delirium Rating Scale-Revised-98 (K-DRS-98) criteria were included. They were assigned to either aripiprazole or quetiapine groups, with a flexible dosing schedule. K-DRS-98 and Clinical Global Impression-Severity (CGI-S) were used for evaluating the severity of delirium. The degree of sedation was assessed by using the Richmond Agitation-Sedation Scale (RASS) six times per day. The severity of side effect was evaluated with the Drug-Induced ExtraPyramidal Symptoms Scale and the Barnes Akathisia Rating Scale. K-DRS-98 and RASS were conducted daily until the remission of delirium while other measurements were conducted twice at the point of baseline and remission. For statistical analysis, t-test, Fisher s exact test, Mann-Whitney test, analysis of covariance were conducted. Results The scores of K-DRS-98 in both groups significantly decreased after treatment (p<0.001), without any significant differences (F=0.294, p=0.591). There were no significant group differences in the duration of remission (p=0.440) and the degree of improvement in the score of CGI-S. In aripiprazole group, there were significantly more numbers of the stable state defined as daily total scores of RASS ≥-3 (p=0.034). The scores on sleep cycle of K-DRS-98-severity more significantly decreased in the quetiapine group than aripiprazole group (F=4.291, p=0.045). There were no significant side effects both groups including extrapyramidal symptoms. Conclusion These results suggest that both aripiprazole and quetiapine appear to be effective and tolerable in the treatment of delirium. Aripiprazole may be less sedative than quetiapine and it may be more useful than aripiprazole in sleep problem of delirium. To validate our results, further studies with double-blind, placebo-controlled with a large sample will be required.