Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis.
Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis.
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DOI：
10.1016/j.jad.2020.09.071
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发表时间：
2021-01-01
影响因子：
6.6
通讯作者：
Zarate CA Jr
中科院分区：
文献类型：
--
作者：
Bahji A;Vazquez GH;Zarate CA Jr
氯胺酮似乎对某些精神疾病有治疗作用，最明显的是抑郁症。然而，氯胺酮不同制剂的比较性能尚不清楚。本研究旨在评估外消旋和艾司氯胺酮治疗单相和双相重度抑郁症的比较疗效和耐受性。系统回顾和荟萃分析.我们检索了PubMed、MEDLINE、Embase、PsycINFO、科克伦对照临床试验中心注册库和科克伦系统评价数据库，以查找自数据库成立以来和2019年12月17日发表的相关研究。我们考虑了随机对照试验，检查外消旋或艾司氯胺酮治疗单相或双相抑郁症。主要结局为抑郁症的反应和缓解、抑郁症严重程度的变化、自杀倾向、治疗保留、脱落和因不良事件而脱落。通过随机效应荟萃分析，将来自随机对照试验的证据合成为治疗应答、疾病缓解、不良事件和退出的率比（RR）以及症状变化的标准化平均差异（SMD）。汇总了代表1877名受试者的24项试验。外消旋氯胺酮相对于艾司氯胺酮表现出更高的总体缓解率（RR = 3.01 vs. RR = 1.38）和缓解率（RR = 3.70 vs. RR = 1.47），以及更低的脱落率（RR = 0.76 vs. RR = 1.37）。静脉注射氯胺酮治疗抑郁症似乎比鼻内艾司氯胺酮更有效。
Ketamine appears to have a therapeutic role in certain mental disorders, most notably depression. However, the comparative performance of different formulations of ketamine is less clear. This study aimed to assess the comparative efficacy and tolerability of racemic and esketamine for the treatment of unipolar and bipolar major depression. Systematic review and meta-analysis. We searched PubMed, MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for relevant studies published since database inception and December 17, 2019. We considered randomized controlled trials examining racemic or esketamine for the treatment of unipolar or bipolar major depression. Primary outcomes were response and remission from depression, change in depression severity, suicidality, retention in treatment, drop-outs, and drop-outs due to adverse events. Evidence from randomized controlled trials was synthesized as rate ratios (RRs) for treatment response, disorder remission, adverse events, and withdrawals and as standardized mean differences (SMDs) for change in symptoms, via random-effects meta-analyses. 24 trials representing 1877 participants were pooled. Racemic ketamine relative to esketamine demonstrated greater overall response (RR = 3.01 vs. RR = 1.38) and remission rates (RR = 3.70 vs. RR = 1.47), as well as lower dropouts (RR = 0.76 vs. RR = 1.37). Intravenous ketamine appears to be more efficacious than intranasal esketamine for the treatment of depression.
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