Adjunctive Use of Nonsteroidal Anti-inflammatory Drugs for Schizophrenia: A Meta-analytic Investigation of Randomized Controlled Trials
Adjunctive Use of Nonsteroidal Anti-inflammatory Drugs for Schizophrenia: A Meta-analytic Investigation of Randomized Controlled Trials
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DOI：
10.1093/schbul/sbt070
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发表时间：
2013-11-01
影响因子：
6.6
通讯作者：
Correll, Christoph U.
中科院分区：
文献类型：
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作者：
Nitta, Masahiro;Kishimoto, Taishiro;Correll, Christoph U.
目的：荟萃分析非甾体抗炎药（NSAIDs）与安慰剂治疗精神分裂症的疗效和耐受性。方法：检索PubMed、PsycINFO、ISI Web of Science和美国国家精神卫生研究所临床试验登记处，从数据库建立到2012年12月31日，我们对评估连续性NSAID疗效的随机安慰剂对照研究进行了系统综述/荟萃分析。主要结果是阳性和阴性症状量表（PANSS）总分的变化。次要结局包括PANSS阳性和阴性分项评分的变化、全因停药和耐受性结局。计算随机效应、合并、标准化平均变化（Hedges' g）和风险比。结果如下：在8项研究中，包括3份未发表的报告（n = 774），PANSS总评分的平均效应量为-0.236（95% CI：-0.484至0.012，P = 0.063，I-2 = 60.6%），仅显示NSAID相对于安慰剂的趋势水平优效性。PANSS阳性和阴性评分的平均效应量分别为-0.189（95% CI：-0.373至-0.005，P = 0.044）和-0.026（95% CI：-0.169至0.117，P = 0.72）。全因停药的相对风险为1.13（95% CI：0.794 - 1.599，P = .503）。NSAID在PANSS总评分方面相对于安慰剂的显著优效性受阿司匹林治疗（N = 2，P = .017）、住院状态（N = 4，P = .029）、首次发作状态（N = 2，P = .048）和（在荟萃回归分析中）较低的PANSS阴性子评分（N = 6，P = .026）的调节。释义：这些结果表明，通过PANSS总分变化判断，精神分裂症的非甾体类抗炎药治疗可能不会使接受一线抗精神病药物治疗的患者获益。NSAID可能对阳性症状有好处，但效果很小。然而，由于数据库有限，需要进一步的对照研究，特别是在首次发作的患者中。
Objective: To meta-analytically assess the efficacy and tolerability of nonsteroidal anti-inflammatory drugs (NSAIDs) vs placebo in schizophrenia. Method: Searching PubMed, PsycINFO, ISI Web of Science, and the US National Institute of Mental Health clinical trials registry from database inception to December 31, 2012, we conducted a systematic review/meta-analysis of randomized placebo-controlled studies assessing the efficacy of adjunctive NSAIDs. Primary outcome was the change in Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcomes included change in PANSS positive and negative subscores, all-cause discontinuation, and tolerability outcomes. Random effects, pooled, standardized mean changes (Hedges' g) and risk ratios were calculated. Results: Across 8 studies, including 3 unpublished reports (n = 774), the mean effect size for PANSS total score was -0.236 (95% CI: -0.484 to 0.012, P = .063, I-2 = 60.6%), showing only trend-level superiority for NSAIDs over placebo. The mean effect sizes for the PANSS positive and negative scores were -0.189 (95% CI: -0.373 to -0.005, P = .044) and -0.026 (95% CI: -0.169 to 0.117, P = .72), respectively. The relative risk for all-cause discontinuation was 1.13 (95% CI: 0.794 to 1.599, P = .503). Significant superiority of NSAIDs over placebo regarding PANSS total scores was moderated by aspirin treatment (N = 2, P = .017), inpatient status (N = 4, P = .029), first-episode status (N = 2, P = .048), and (in meta-regression analyses) lower PANSS negative subscores (N = 6, P = .026). Interpretation: These results indicate that adjunctive NSAIDs for schizophrenia may not benefit patients treated with first-line antipsychotics judged by PANSS total score change. NSAIDs may have benefits for positive symptoms, but the effect was minimal/small. However, due to a limited database, further controlled studies are needed, especially in first-episode patients.