急性躁病における抗躁病薬の比較効果と受容性:複数の治療法によるメタ解析
Andrea Cipriani1, Corrado Barbui, Georgia Salanti
1Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Italy. andrea.cipriani@univr.it
Lancet (London, England)
|August 20, 2011
まとめ
リスペリドン,オランザピン,およびハロペリドールは,急性マニアの効果的な治療法であり,プラセボおよび他のいくつかの薬よりも高い有効性を示しています. これらの抗精神病薬は,躁病エピソードを管理するための好ましい選択肢かもしれません.
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
- 根拠に基づいた医学は,エビデンスに基づいた医療です.
背景:
- 従来のメタアナリシスは,急性マニアの薬理学的治療について矛盾する結果を示しています.
- 直接的および間接的な比較を通じて抗躁うつ薬の有効性を評価するために,複数の治療法のメタ分析が行われました.
研究 の 目的:
- 急性マニアの様々な薬理学的治療法の有効性を比較する.
- 総合的なメタアナリシスに基づいて,最も効果的な抗マニア薬物を特定する.
主な方法:
- 1980年から2010年までの68件のランダム化比較試験 (16,073人の参加者) の系統的レビュー.
- 薬剤は,アリピプラゾール,アセナピン,カルバマゼピン,バルプロアート,ガバペンチン,ハロペリドール,ラモトリジン,リチウム,オランザピン,ケチアピン,リスペリドン,トピラマート,ジプラシドンが含まれています.
- 主なアウトカム:マニアの評価スケールの変化と3週間の患者の脱退率;治療の意図分析.
主要な成果:
- ハロペリドール,リスペリドン,オランザピン,リチウム,ケチアピン,アリピプラゾール,カルバマゼピン,アセナピン,バルプロアート,ジプラシドンはプラセボよりも効果的でした.
- ハロペリドールは最も多くの有意な差異を示し,リチウム,ケチアピン,アリピプラゾール,カルバマゼピン,アセナピン,バルプロ酸,ジプラシドン,ラモトリジン,トピラマート,ガバペンチンよりも有効でした.
- オランザピン,リスペリドン,クエチアピンは,リチウム,ラモトリジン,プラセボ,トピラマート,ガバペンチンと比較して治療中止が少なくなった.
結論:
- 抗精神病薬は,急性マニアの気分安定剤よりも著しく高い有効性を示しました.
- リスペリドン,オランザピン,ハロペリドールは,躁病エピソードのトップ治療選択肢として推奨されています.
- 発見は,急性マニアの治療のための最新の臨床実務ガイドラインの開発を支援しています.
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