素与SSRI或SNRI结合用于治疗耐药抑郁症
Antonio Del Casale1,2, Sara Spirito3, Jan Francesco Arena1
1Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
JAMA psychiatry
|April 2, 2025
概括
与色胺 - 上腺素再吸收抑制剂 (SNRIs) 结合使用埃斯凯他明,与选择性色胺再吸收抑制剂 (SSRI) 相比,治疗耐药性抑郁症的死亡率,住院和抑郁复发率较低. 在SSRI的患者中,自杀企图略有减少.
科学领域:
- 精神病学和药理学 精神病学和药理学
- 临床有效性研究研究 临床有效性研究
- 现实世界的证据研究研究.
背景情况:
- 耐治疗性抑郁症 (TRD) 是一个重大的临床挑战,治疗选择有限.
- 胺是一种快速起作用的抗抑郁药,通常与SSRI或SNRIs一起使用,但现实世界的比较数据很少.
研究的目的:
- 为了比较ESKETAMINE加SNRI与ESKETAMINE加SSRI在TRD患者的临床结果.
- 评估两种组合疗法之间的死亡率,住院,抑郁复发和自杀企图的差异.
主要方法:
- 使用TriNetX全球健康研究网络 (2024年9月) 的回顾性队列研究.
- 包括 TRD 的成年人,接受了艾斯基坦胺治疗,再加上SSRI或SNRI.
- 倾向性得分匹配被用来创建可比的队列 (每组n=27,740).
- 卡普兰-梅尔分析和风险/赔率比率评估了主要结果.
主要成果:
- 乙胺+SNRI组与乙胺+SSRI组相比,显著降低了全因死亡率 (5.3%对9.1%),住院率 (0.1%对0.2%) 和抑郁复发率 (14.8%对21.2%).
- 乙胺+SSRI组的自杀企图发生率略低 (0.3%对0.5%).
- 在这两组中,不良结果的总体发病率都很低.
结论:
- 与SSRI组合相比,Esketamine与SNRIs结合似乎与TRD患者的死亡率,住院和复发的更好结果有关.
- 虽然SSRI组合表明自杀尝试减少的趋势,但可能需要进一步的研究.
- 这些发现为优化TRD治疗策略提供了有价值的现实世界的证据.
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