Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials
Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials
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DOI：
10.1159/000369978
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发表时间：
2015-01-01
影响因子：
22.8
通讯作者：
Kasper, Siegfried
中科院分区：
文献类型：
--
作者：
Dold, Markus;Aigner, Martin;Kasper, Siegfried
背景：第二代抗精神病药物(SGA)越来越多地用于神经性厌食症患者的体重增加。在这项荟萃分析中，我们的目标是确定是否可以从随机对照试验(RCT)中得出这种治疗方案的任何证据。方法：根据世界生物精神病学学会联合会(WFSBP)的饮食障碍药理学治疗指南，通过系统的最新文献检索，确定所有研究SGAs在神经性厌食症中的有效性、可接受性和耐受性的随机对照试验，并与安慰剂/不治疗进行比较。主要结果是通过体重指数(BMI)的平均变化来衡量体重增加。次要结果是耶鲁-布朗-康奈尔进食障碍量表(YBC-EDS)总分和进食障碍问卷(EDI)总分的平均变化以及过早停止治疗。采用随机效应模型，计算了基于赫奇斯g和Mantel-Haenszel风险比的标准化平均差值。结果：共纳入7个随机对照试验(n=201)，分别研究奥氮平(N=4)、奎硫平(N=2)和利培酮(N=1)。我们发现，在合并SGA(N=7，n=161；Hedge‘s g=0.13，95%CI：-0.17~0.43；p=0.4)和检查单独用药时，平均BMI变化在组间没有统计学差异。此外，在所有次要结果中，SGAS与安慰剂/不治疗的结果在统计学上没有显著区别。结论：根据目前的证据，尽管一些个体或患者亚组可能受益于抗精神病药物，但不能普遍推荐使用SGAS进行神经性厌食症的药物治疗。需要进一步的研究来确定哪些患者可能从这种治疗方案中受益。(C)2015年S.Karger AG，巴塞尔
Background: Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the 'World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were mean changes in Yale-Brown- Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: - 0.17 to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required to identify which patients will likely benefit from such a treatment option. (C) 2015 S. Karger AG, Basel