Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.
Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.
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DOI：
10.1017/s1461145712001277
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Correll CU
中科院分区：
文献类型：
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作者：
Zhang JP;Gallego JA;Robinson DG;Malhotra AK;Kane JM;Correll CU
由于早期治疗选择对首发精神分裂症谱系障碍（FES）至关重要，因此本荟萃分析比较了第二代抗精神病药（SGA）与第一代抗精神病药（FGA）治疗FES的疗效和耐受性。我们进行了系统性文献检索（截至2010年12月31日）和荟萃分析，研究对象包括：比较≥1次FGA与SGA的急性随机试验;首次精神病发作并诊断为精神分裂症谱系障碍的患者;精神病理学变化、治疗应答、治疗中止、不良反应或认知的可用数据。在13项试验（n= 2，509）中，奥氮平（7项试验）和氨磺必利（1项试验）分别在9/13项和8/13项疗效结局中优于FGA（氟哌啶醇：9/13项试验），利培酮（8项试验）在4/13项中优于FGA，奎替鲁（1项试验）在3/13项中优于FGA，氯氮平（2项试验）和齐拉西酮（1项试验）各在1/13项中优于FGA。与FGA相比，奥氮平、利培酮和氯氮平的EPS相关结局较不常见，但氯氮平、奥氮平和利培酮的体重增加较大。汇总的SGA在总体精神病理学变化、抑郁、治疗反应和代谢变化方面与FGA相似。SGAs在减少治疗中断（不考虑原因）、阴性症状、整体认知、EPS和静坐不能较少方面显著优于FGA，而SGAs增加体重更多（p <0.05-0.01）。结果不受FGA剂量或发表偏倚的影响，但行业赞助的研究比联邦资助的研究更倾向于SGAs。总之，在FES中，奥氮平、氨磺必利和利培酮和奎替利显示出优于FGA上级疗效、更大的治疗持久性和更少的EPS。然而，奥氮平、利培酮和氯氮平的体重增加以及奥氮平的代谢变化更大。需要进行更多的FES研究，包括基础更广泛的SGA和FGA。
Because early treatment choice is critical in first episode schizophrenia-spectrum disorders (FES), this meta-analysis compared efficacy and tolerability of individual second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) in FES. We conducted systematic literature search (until 12/31/2010) and meta-analysis of acute, randomized trials with ≥1 FGA vs. SGA comparison; patients in their first episode of psychosis and diagnosed with schizophrenia-spectrum disorders; available data for psychopathology change, treatment response, treatment discontinuation, adverse effects, or cognition. Across 13 trials (n=2,509), olanzapine (7 trials) and amisulpride (1 trial) outperformed FGAs (haloperidol: 9/13 trials) in 9/13 and 8/13 efficacy outcomes, respectively, risperidone (8 trials) in 4/13, quetiapine (1 trial) in 3/13, and clozapine (2 trials) and ziprasidone (1 trial) in 1/13, each. Compared to FGAs, EPS-related outcomes were less frequent with olanzapine, risperidone and clozapine, but weight gain was greater with clozapine, olanzapine and risperidone. Pooled SGAs were similar to FGAs regarding total psychopathology change, depression, treatment response, and metabolic changes. SGAs significantly outperformed FGAs regarding lower treatment discontinuation, irrespective of cause, negative symptoms, global cognition, and less EPS and akathisia, while SGAs increased weight more (p’s<0.05-0.01). Results were not affected by FGA dose or publication bias, but industry-sponsored studies favored SGAs more than federally funded studies. To summarize, in FES, olanzapine, amisulpride and, less so, risperidone and quetiapine showed superior efficacy, greater treatment persistence and less EPS than FGAs. However, weight increase with olanzapine, risperidone and clozapine and metabolic changes with olanzapine were greater. Additional FES studies including broader-based SGAs and FGAs are needed.