Recurrence rates in stable bipolar disorder patients after drug discontinuation v. drug maintenance: a systematic review and meta-analysis
Recurrence rates in stable bipolar disorder patients after drug discontinuation v. drug maintenance: a systematic review and meta-analysis
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DOI：
10.1017/s0033291720003505
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发表时间：
2021-11-01
影响因子：
6.9
通讯作者：
Iwata, Nakao
中科院分区：
文献类型：
--
作者：
Kishi, Taro;Matsuda, Yuki;Iwata, Nakao
本随机效应模型荟萃分析双盲、随机安慰剂对照试验，比较停药组和维持组双相情感障碍（BD）患者的复发率。方法我们对Embase、PubMed和CENTRAL数据库进行了系统的文献检索，从开始到2020年5月22日，没有语言限制。独立研究者评估研究并提取数据。我们计算了风险比（RR）和获益或损害所需的数量（NNTB/NNTH）。主要结果是6个月时任何情绪发作的复发率。次要结局是6个月时抑郁发作和躁狂/轻躁狂/混合发作的复发率和全因停药。我们还研究了1、3、9、12、18和24个月时的这些结局。结果：我们确定了22项研究（n = 5462），接受阿立哌唑，阿森那肽，双丙戊酸，长效注射剂（LAI）-阿立哌唑，LAI-利培酮，拉莫三嗪，锂，奥氮平，帕利哌酮，或奎替利。平均研究持续时间为64.50 ± 69.35周。维持组表现出任何情绪发作、抑郁发作和躁狂/轻躁狂/混合发作的复发率较低，并且在每个观察点的全因停药减少。6个月时复发率的RR（95%置信区间，NNTB/NNTH）为：任何情绪发作0.61（0.54 - 0.70，5），抑郁发作0.72（0.60 - 0.87，13），躁狂/轻躁狂/混合发作0.45（0.36 - 0.57，6）。6个月时全因停药的RR为0.71（0.61 - 0.82，6）。结论在临床稳定的BD期间维持药物治疗可预防复发长达24个月。停药> 1个月显著增加复发风险。然而，47.3%的停药6个月的患者没有复发。
Background This random-effects model meta-analysis of double-blind, randomized placebo-controlled trials compared recurrence rates in bipolar disorder (BD) patients between antipsychotic/mood stabilizer discontinuation and maintenance groups. Methods We conducted systematic literature search of Embase, PubMed, and CENTRAL databases without language restriction from inception until 22 May 2020. Independent investigators assessed studies and extracted data. We calculated risk ratios (RRs) and numbers needed to benefit or harm (NNTB/NNTH). Primary outcome was the recurrence rate of any mood episode at 6 months. Secondary outcomes were recurrence rates of depressive episodes and manic/hypomanic/mixed episodes and all-cause discontinuation at 6 months. We also investigated these outcomes at 1, 3, 9, 12, 18, and 24 months. Results We identified 22 studies (n = 5462) receiving aripiprazole, asenapine, divalproex, long-acting injectable (LAI)-aripiprazole, LAI-risperidone, lamotrigine, lithium, olanzapine, paliperidone, or quetiapine. Mean study duration was 64.50 +/- 69.35 weeks. The maintenance group demonstrated lower recurrence rates of any mood episode, depressive episodes, and manic/hypomanic/mixed episodes as well as reduced all-cause discontinuation at every observational point. The RRs (95% confidence interval, NNTB/NNTH) of recurrence rate at 6 months were 0.61 (0.54-0.70, 5) for any mood episode, 0.72 (0.60-0.87, 13) for depressive episodes, and 0.45 (0.36-0.57, 6) for manic/hypomanic/mixed episodes. The RR for all-cause discontinuation at 6 months was 0.71 (0.61-0.82, 6). Conclusions Maintaining drug treatment during clinically stable BD prevented recurrence for up to 24 months. Discontinuation of medications for > 1 month significantly increased recurrence risk. However, 47.3% of patients who discontinued drugs for 6 months did not experience recurrence.