Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis
Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis
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DOI：
10.1136/bmj.321.7273.1371
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发表时间：
2000-12-02
影响因子：
--
通讯作者：
Bebbington, P
中科院分区：
文献类型：
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作者：
Geddes, J;Freemantle, N;Bebbington, P
目的建立非典型抗精神病药治疗精神分裂症的循证医学证据库，为临床推荐非典型抗精神病药治疗精神分裂症提供依据。方法对52项随机对照试验的12 649例患者进行系统综述和荟萃回归分析，比较非典型抗精神病药治疗精神分裂症的疗效和不良反应。（氨磺必利、氯氮平、奥氮平、奎替利、利培酮和舍吲哚）与常规抗精神病药（通常为氟哌啶醇或氯丙嗪）或替代的非典型抗精神病药联用。率的辍学LAS代理的耐受性）和副作用，特别是锥体外系的副作用。结果为症状减轻和辍学，有很大的异质性之间的试验结果，包括那些评估相同的非典型抗精神病药物和比较药物。Meta回归分析显示，常规抗精神病药物剂量可以解释异质性。当剂量小于或等于12毫克/天的氟哌啶醇（或等效），非典型抗精神病药物的疗效或总体耐受性方面没有任何好处，但他们仍然造成较少的锥体外系副作用。结论有没有明确的证据表明，非典型抗精神病药物比传统的抗精神病药物更有效或更好的耐受性。常规抗精神病药物通常应用于精神分裂症发作的初始治疗，除非患者以前对这些药物无反应或有不可接受的锥体外系副作用。
Objective To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia.Design Systematic overview and meta-regression analyses of randomised controlled trials, as a basis for formal development of guidelines.Subjects 12 649 patients in 52 randomised trials comparing atypical antipsychotics (amisulpride, clozapine, olanzapine, quetiapine, risperidone, and sertindole) with conventional antipsychotics (usually haloperidol or chlorpromazine) or alternative atypical antipsychotics.Main outcome measures Overall symptom scores. Rate of drop out las a proxy for tolerability) and of side effects, notably extrapyramidal side effects.Results For both symptom reduction and drop out, there was substantial heterogeneity between the results of trials, including those evaluating the same atypical antipsychotic and comparator drugs. Meta-regression suggested that dose of conventional antipsychotic explained the heterogeneity. When the dose was less than or equal to 12 mg/day of haloperidol (or equivalent), atypical antipsychotics had no benefits in terms of efficacy or overall tolerability, but they still caused fewer extrapyramidal side effects.Conclusions There is no clear evidence that atypical antipsychotics are more effective or are better tolerated than conventional antipsychotics. Conventional antipsychotics should usually be used in the initial treatment of an episode of schizophrenia unless the patient has previously not responded to these drugs or has unacceptable extrapyramidal side effects.