Efficacy and safety of noradrenalin reuptake inhibitor augmentation therapy for schizophrenia: a meta-analysis of double-blind randomized placebo-controlled trials.
Efficacy and safety of noradrenalin reuptake inhibitor augmentation therapy for schizophrenia: a meta-analysis of double-blind randomized placebo-controlled trials.
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去甲肾上腺素再摄取抑制剂增强治疗精神分裂症的疗效和安全性：双盲随机安慰剂对照试验的荟萃分析。
DOI：
10.1016/j.jpsychires.2013.07.003
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发表时间：
2013
期刊：
影响因子：
4.8
通讯作者：
Iwata N.
中科院分区：
文献类型：
--
作者：
Kishi T;Mukai T;Matsuda Y;Moriwaki M;Iwata N.
背景我们在先前的荟萃分析(Singh et al.)的基础上，对接受抗精神病药物治疗的精神分裂症患者进行了去甲肾上腺素重摄取抑制剂(NRI)强化治疗的最新荟萃分析。方法检索PubMed、Cochrane图书馆数据库和CogcINFO从最初到2013年6月10日的引文，没有语言限制。我们对来自随机对照试验的个体患者数据进行了系统的回顾和荟萃分析，比较了NRI增强疗法和安慰剂。疗效的结果衡量标准是精神分裂症的精神病理学，安全性的衡量标准是停药率和几种副作用。我们使用标准化均数差(SMD)来评估连续变量的治疗效果，并使用风险比(RR)来评估二分变量的治疗效果，其95%的可信区间(CI)。结果共纳入9篇研究，其中4篇为托莫西汀研究，3篇为瑞波西汀研究，1篇为瑞波西汀-倍他司汀联合研究，1篇为马吲哚研究，共298篇。NRI增强治疗对总症状(p=100.90)、阳性症状(p=100.81)和阴性症状(p=100.89)没有统计学意义的影响。在抑郁症状的疗效方面，神经阻力指数增强疗法略优于安慰剂(Smd=−1.08，p=0.05)。在两组患者中，由于各种原因(p=0.70)、无效(p=0.64)或不良事件(p=0.18)而退出的情况相似。与安慰剂相比，神经阻力指数增强治疗显示体重增加或更大幅度的体重增加显著减少(Smd=−0.47，p=0.03)。在接受抗精神病药物治疗的精神分裂症患者中，瑞波西汀增加的体重增加比安慰剂少(−=0.78，p=0.0001)。结论NRIs可能对抑郁症状有影响，而且似乎是一种耐受性良好的治疗方法。
BackgroundWe performed an updated meta-analysis of noradrenalin reuptake inhibitor (NRI) augmentation therapy in patients with schizophrenia treated with antipsychotics based on a previous meta-analysis (Singh et al.).MethodsPubMed, Cochrane Library databases, and PsycINFO citations were searched from their inception to June 10, 2013 without language restrictions. We conducted a systematic review and meta-analysis of individual patient data from randomized controlled trials comparing NRI augmentation therapy with placebo. The outcome measure for efficacy was the psychopathology of schizophrenia and the measures for safety were discontinuation rate and several side effects. We used standardized mean differences (SMD) to estimate treatment effects for continuous variables, and risk ratios (RR) for dichotomous variables, with their 95% confidence intervals (CIs). A random-effects model was used.ResultsNine studies (4 atomoxetine studies, 3 reboxetine studies, 1 reboxetine–betahistine combination study and 1 mazindol study, totaln= 298) were identified. No statistically significant effects of NRI augmentation therapy on overall (p= 0.90), positive (p= 0.81), and negative (p= 0.89) symptoms were found. NRI augmentation therapy was marginally superior to placebo for efficacy of depressive symptoms (SMD = −1.08,p= 0.05). Dropout due to all-cause (p= 0.70), inefficacy (p= 0.64), or adverse events (p= 0.18) was similar in both groups. NRI augmentation therapy showed a significantly lower increase or larger reduction in body weight than placebo (SMD = −0.47,p= 0.03). Reboxetine augmentation was associated with less weight gain that placebo in antipsychotic treated schizophrenia patients (SMD = −0.78,p= 0.0001).ConclusionNRIs may exert an effect on depressive symptoms, and seem to be well-tolerated treatments.