新一代抗精神病药与低强度常规抗精神病药:系统性审查和元分析
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
概括
较新的抗精神病药物可能不会减少额外皮拉米德副作用 (EPS) 与较旧的低强度药物的最佳剂量相比. 克洛扎宾的EPS显著减少,而其他新药的效果不一.
科学领域:
- 精神病学是一个精神病学.
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 较新的非典型抗精神病药物被认为比传统抗精神病药物具有较少的外皮拉米德副作用 (EPS).
- 以前的比较可能会因使用高强度比较药物 (如利) 而产生偏差.
研究的目的:
- 为了确定新一代抗精神病药是否会导致较少的EPS与低强度常规抗精神病药相比.
- 评估非典型与常规抗精神病药物的比较疗效和安全性.
主要方法:
- 31个随机对照试验的元分析,涉及2320名参与者.
- 包含符合"柯克伦协作手册"质量标准A或B的研究,根据Jadad尺度进行评估.
- 主要结局:至少有一个EPS的发病率. 用风险差异和95%的置信区间 (CI) 来衡量效应大小.
主要成果:
- 克洛扎宾是唯一一代新型抗精神病药物,与较少的EPS (RD=-0.15,95%CI-0.26至-0.4) 和较高的疗效相比,与低强度常规药物有显著的关联.
- 奥兰zapine显示了EPS的边界显著减少 (RD=-0.15,95%CI-0.31至-0.01).
- 低强度的常规抗精神病药物剂量低于600毫克/天的 хлорпромазин相当剂量没有显示出比新一代药物更高的EPS风险. 新一代药物作为一个群体是中度更有效的.
结论:
- 低强度常规抗精神病药物的最佳剂量可能具有与新一代药物相似的EPS风险.
- 新一代抗精神病药物的潜在疗效优势应在临床治疗决策中考虑.
- 与低强度药物相比,对阿米苏普里德,奎平,瑞斯佩里,齐普拉西和塞尔多尔进行进一步的研究是必要的.
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