Meta-Analysis of Selective Serotonin Reuptake Inhibitor-Associated QTc Prolongation
Meta-Analysis of Selective Serotonin Reuptake Inhibitor-Associated QTc Prolongation
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DOI：
10.4088/jcp.13r08672
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发表时间：
2014-05-01
影响因子：
5.3
通讯作者：
Huffman, Jeff C.
中科院分区：
文献类型：
--
作者：
Beach, Scott R.;Kostis, William J.;Huffman, Jeff C.
目的：通过前瞻性研究的荟萃分析，评价选择性5-羟色胺再摄取抑制剂（SSRI）与校正QT间期（QTc）延长之间的相关性。数据来源：PubMed/MEDLINE数据库（1975年1月1日至2012年8月15日），使用手动检索相关文章的参考文献列表识别其他报告。检索的关键词为QT、尖端扭转型室性心动过速和心源性猝死，与抗抑郁药、西酞普兰、艾司西酞普兰、氟西汀、舍曲林、帕罗西汀和氟伏沙明联用。研究选择：两名评价者独立确定了在成人中进行的前瞻性对照研究，这些研究报告了SSRIs治疗前后QTc间期的相关数据。数据提取和合成：三名评价者独立提取了研究水平的数据，包括人群特征、QTc测量方法、治疗和结局数据。两名独立评审员对研究质量进行了评价。使用漏斗图和定量方法对发表偏倚进行了目视评估。结果：共纳入16篇文献（25个不同的数据子集），涉及4,292例患者。与安慰剂相比，SSRIs与QTc间期的剂量依赖性延长相关（+6.10毫秒; 95%CI，3.47-8.73; P
Objective: To evaluate the association between selective serotonin reuptake inhibitors (SSRIs) and corrected QT interval (QTc) prolongation via meta-analysis of prospective studies.Data Sources: PubMed/MEDLINE database (January 1, 1975-August 15, 2012), with additional reports identified using hand searches of reference lists of relevant articles. Key words searched were QT, torsades de pointes, and sudden cardiac death, combined with antidepressants, citalopram, escitalopram, fluoxetine, sertraline, paroxetine, and fluvoxamine. English-, Spanish-, and German-language articles were included.Study Selection: Two reviewers independently identified prospective controlled studies in adults that reported data related to QTc intervals prior to and following treatment with SSRIs.Data Extraction and Synthesis: Three reviewers independently extracted study-level data including population characteristics, method of QTc measurement and treatment and outcome data. Two independent reviewers critiqued study quality. Publication bias was assessed visually using a funnel plot and quantitatively. Heterogeneity was measured using Cochran Q statistic.Results: Sixteen articles (with 25 distinct data subsets) involving 4,292 patients were included. SSRIs were associated with a dose-dependent increase in QTc interval compared to placebo (+ 6.10 milliseconds; 95% CI, 3.47-8.73; P