Efficacy and tolerability of different doses of three new antidepressants for treating major depressive disorder: A PRISMA-compliant meta-analysis
Efficacy and tolerability of different doses of three new antidepressants for treating major depressive disorder: A PRISMA-compliant meta-analysis
复制标题
三种新型抗抑郁药不同剂量治疗重度抑郁症的疗效和耐受性：符合 PRISMA 标准的荟萃分析
DOI：
10.1016/j.jpsychires.2017.10.018
复制
发表时间：
2018
影响因子：
4.8
通讯作者：
Ma Xiancang
中科院分区：
文献类型：
--
作者：
He Hairong;Wang Wei;Lyu Jun;Zheng Jie;Guo Liyang;An Xiaofang;Fan Yajuan;Ma Xiancang
在过去的十年中，美国FDA批准了三种新的抗抑郁药：沃替西汀，左旋米那普仑和维拉唑酮。许多研究已经研究了这些抗抑郁药对重度抑郁症（MDD）的影响，但他们没有确定最佳剂量。本荟萃分析研究了这三种药物在不同剂量下治疗MDD的疗效。检索PubMed、Embase、科克伦图书馆、psycINFO和www.example.com数据库，以识别相关文献。主要结局为疗效[量化为蒙哥马利-艾斯伯格抑郁量表（MADRS）总分较基线的变化]和耐受性（因不良事件而停药）。效应量被量化为连续数据的加权平均差和二分数据的风险比（RR）。共纳入22项研究。沃替西汀5、10、20和10 - 20 mg/天组的MADRS总分变化显著高于安慰剂组。20 mg/天沃替西汀的耐受性显著差于安慰剂（RR = 1.84，95%置信区间= 1.13 - 3.02）。此外，增加剂量可改善沃替西汀的疗效，但使耐受性恶化。与安慰剂相比，任何剂量的左米那普仑和维拉唑酮均导致MADRS总评分较基线的平均变化显著更高，耐受性更差。总之，考虑到疗效和耐受性，10 mg/天沃替西汀可能是治疗MDD的最佳剂量。沃替西汀的长期疗效和安全性有待进一步研究，左旋米那普仑和维拉唑酮的最佳剂量有待进一步研究。
In last decade, the US FDA has approved three new antidepressants: vortioxetine, levomilnacipran, and vilazodone. Many studies have researched the effects of these antidepressants on major depressive disorder (MDD), but they have not determined the optimum dosage. This meta-analysis investigated the efficacies of these three drugs at different dosages in the treatment of MDD. The PubMed, Embase, Cochrane Library, psycINFO, and ClinicalTrials.gov databases were searched to identify relevant literature. The primary outcomes were efficacy [quantified as the change from baseline in total score on the Montgomery-Asberg Depression Rating Scale (MADRS)] and tolerability (discontinuations due to adverse events). The effect size was quantified as the weighted mean difference for continuous data and the risk ratio (RR) for dichotomous data. Overall 22 studies were included. The changes in the MADRS total score were significantly higher for vortioxetine at 5, 10, 20, and 10–20 mg/day than for placebo. The tolerability was significantly worse for 20 mg/day vortioxetine than for placebo (RR = 1.84, 95% confidence interval = 1.13 to 3.02). In addition, increasing the dosage improved the efficacy of vortioxetine but worsened the tolerability. Levomilnacipran and vilazodone at any dosage produced a significantly higher mean change from baseline in the MADRS total score and a worse tolerability than for placebo. In conclusion, considering both efficacy and tolerability, 10 mg/day vortioxetine might be optimal for the treatment of MDD. The long-term efficacy and safety of vortioxetine needed to be investigated, and more studies of levomilnacipran and vilazodone are needed to define their optimal dosages.