A Pilot Study of the Effectiveness of Lithium Versus Quetiapine Immediate Release Monotherapy in Patients With Bipolar Spectrum Disorders
A Pilot Study of the Effectiveness of Lithium Versus Quetiapine Immediate Release Monotherapy in Patients With Bipolar Spectrum Disorders
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DOI：
10.1097/jcp.0000000000000927
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发表时间：
2018-10-01
影响因子：
2.9
通讯作者：
Calabrese, Joseph R.
中科院分区：
文献类型：
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作者：
Gao, Keming;Goto, Toyomi;Calabrese, Joseph R.
目的 本研究的目的是比较锂盐与喹硫平速释 (IR) 单药治疗对 I、II 型双相情感障碍或阈下双相情感障碍患者任何阶段的疗效。 方法 符合条件的患者被随机接受锂盐或喹硫平 IR 治疗，疗程为 16 周。比较了锂盐组和喹硫平速释组之间因各种原因而终止研究的时间差异，以及从基线到 8 周和 16 周的抑郁、躁狂、焦虑、生活质量 (QOL)、代谢特征和促炎标志物的变化。结果 在随机分配到锂盐组 (n = 18) 和喹硫平速释组 (n = 24) 的 42 名患者中，由于各种原因而终止研究的中位时间为 6 周 (95%)锂盐组为 8 周（95% 置信区间，2-12 周），喹硫平 IR 组为 8 周（95% 置信区间，6 周至无法计算）。锂剂因各种原因停药的平均时间为 7.7 ± 1.1 周，而喹硫平速释片为 8.4 ± 0.8 周（P = 0.54）。锂盐和喹硫平 IR 在抑郁、躁狂/轻躁狂、焦虑和生活质量的严重程度变化方面没有显着差异，或者仅在抑郁指数发作的患者中。总体而言，锂剂组的总胆固醇降低量显着大于喹硫平 IR (P = 0.05)，但不仅限于抑郁指数发作的患者。两组之间代谢组和炎症标志物的变化没有其他显着差异。 结论 在现实世界的双相情感障碍人群中，锂盐和喹硫平速释单一疗法之间的有效性差异很小。需要大样本研究来支持或反驳这一发现。
Objective The aim of this study was to compare the effectiveness of lithium versus quetiapine immediate release (IR) monotherapy in patients with bipolar I, II, or subthreshold bipolar disorder at any phase.Methods Eligible patients were randomized to lithium or quetiapine IR for 16 weeks. The difference in the time to discontinuation from study due to all causes between lithium and quetiapine IR groups and changes from baseline to 8 and 16 weeks in depression, mania, anxiety, quality of life (QOL), metabolic profiles, and proinflammatory markers were compared.Results Of the 42 patients randomized to lithium (n = 18) and quetiapine IR (n = 24), the median time to discontinuation due to all causes was 6 weeks (95% confidence interval, 2-12 weeks) in the lithium group and 8 weeks (95% confidence interval, 6 weeks to not calculable) in the quetiapine IR group. The mean time to discontinuation due to all causes was 7.7 1.1 weeks for lithium versus 8.4 +/- 0.8 weeks for quetiapine IR (P = 0.54). There was no significant difference between lithium and quetiapine IR in changes in the severity of depression, mania/hypomania, anxiety, and QOL as a whole or only in patients with depressive index episode. The decrease in total cholesterol was significantly larger with lithium than with quetiapine IR (P = 0.05) as a whole, but not only in patients with depression index episode. There was no other significant difference in changes in metabolic panels and inflammatory markers between the 2 groups.Conclusions The difference in effectiveness between lithium and quetiapine IR monotherapy in a real-world bipolar population was minimal. Large-sample studies are needed to support or refute this finding.