新世代の抗精神病薬と低効能の従来の抗精神病薬:体系的なレビューとメタ解析
Stefan Leucht1, Kristian Wahlbeck, Johannes Hamann
1Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, München, Germany. stefan.leucht@lrz.tum.de <stefan.leucht@lrz.tum.de>
Lancet (London, England)
|May 16, 2003
まとめ
より新しい抗精神病薬は,より古い低効力薬の最適な用量と比較して,エクストラピラミダル副作用 (EPS) を軽減しない可能性があります. クロザピンはEPSを大幅に減らし,他の新薬は混合的な結果を示しました.
科学分野:
- 精神科医は精神病を患っている.
- 薬理学 薬理学とは
- クリニック・トライアル 臨床試験
背景:
- より新しい非典型抗精神病薬は,従来の抗精神病薬よりも,より少ないエクストラピラミダル副作用 (EPS) を有すると考えられています.
- 以前の比較は,ハロペリドールなどの高効能比較薬の使用によって偏りがある可能性があります.
研究 の 目的:
- 新世代の抗精神病薬が低効能の従来の抗精神病薬と比較してEPSを少なくするかどうかを判断する.
- 非典型抗精神病薬と従来の抗精神病薬の比較効果と安全性を評価する.
主な方法:
- 2320人の参加者を含む31件のランダム化比較試験のメタ分析.
- コクラン・コラボレーション・ハンドブック (Cochrane Collaboration Handbook) の品質基準AまたはBを満たした研究を含む.
- 主要アウトカム:少なくとも1つのEPS.の発生率. リスク差と95%信頼区間 (CI) で測定された効果サイズ.
主要な成果:
- クロザピンは,新世代の抗精神病薬として,EPSの減少 (RD=-0.15,95%CI-0.26〜-0.4) と,低効能の従来の薬と比較してより高い有効性との有意な関連性を持つ唯一の新世代の抗精神病薬でした.
- オランザピンは,EPSの境界的な有意な減少を示した (RD=-0.15,95%CI-0.31から-0.01).
- 低効能の従来の抗精神病薬は,クロロプロマジン相当の600mg/日未満の投与量では,新世代の薬よりもEPSのリスクが高くなかった. 新世代の薬は,グループとして,適度に有効でした.
結論:
- 低効能の従来の抗精神病薬の最適な用量は,新世代の薬と同様のEPSのリスクを伴う可能性があります.
- 新世代の抗精神病薬の潜在的な有効性の利点は,臨床治療の決定に考慮されるべきである.
- 低効能薬と比較してアミスルプリド,クエチアピン,リスペリドン,ジプラシドン,サーティンドールについてさらなる研究が必要である.
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