Einarson T R, Arikian S R, Casciano J, Doyle J J
Faculty of Pharmacy, University of Toronto, and Department of Clinical Pharmacology, Hospital for Sick Children, Ontario, Canada.
Clin Ther. 1999 Feb;21(2):296-308. doi: 10.1016/S0149-2918(00)88287-9.
The purpose of this study was to summarize and compare the clinical success rates of extended-release venlafaxine, some selective serotonin reuptake inhibitors (SSRIs), and certain tricyclic antidepressants (TCAs). A meta-analytic approach was used to synthesize outcomes from published randomized controlled trials involving patients scoring > or =15 on the Hamilton Rating Scale for Depression (HAM-D) or > or =18 on the Montgomery-Asberg Depression Rating Scale (MADRS). Searches of the MEDLINE, EMBASE, and International Pharmaceutical Abstracts databases were performed, as were searches of references from retrieved articles and reviews. Drugs included in the comparison were extended-release venlafaxine (venlafaxine-XR); the SSRIs citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline; and the TCAs amitriptyline, imipramine, desipramine, and nortriptyline. Therapeutic success was defined as a 50% decrease in the HAM-D or MADRS score. Data were extracted by 2 independent evaluators, with differences resolved through consensus discussions. Weighted mean success rates were calculated for each drug class, using a random-effects model. The resulting data represent 44 trials with 63 study arms and 4033 patients with depression. Venlafaxine-XR demonstrated a 73.7% success rate, which was statistically significantly greater than that of the studied SSRIs (61.1%) and TCAs (57.9%) (P<0.001). Thus this meta-analysis of randomized controlled studies of patients with depression suggests that venlafaxine-XR is clinically superior in efficacy to SSRIs and TCAs. Venlafaxine-XR also had universally lower, though nonsignificant, dropout rates.
本研究旨在总结并比较缓释文拉法辛、某些选择性5-羟色胺再摄取抑制剂（SSRI）及某些三环类抗抑郁药（TCA）的临床成功率。采用荟萃分析方法，综合已发表的随机对照试验结果，这些试验的受试患者在汉密尔顿抑郁量表（HAM-D）上得分≥15或在蒙哥马利-阿斯伯格抑郁量表（MADRS）上得分≥18。检索了MEDLINE、EMBASE和国际药学文摘数据库，同时也检索了检索到的文章及综述中的参考文献。纳入比较的药物有缓释文拉法辛（venlafaxine-XR）；SSRI类药物西酞普兰、氟西汀、氟伏沙明、帕罗西汀和舍曲林；以及TCA类药物阿米替林、丙咪嗪、地昔帕明和去甲替林。治疗成功定义为HAM-D或MADRS评分降低50%。由两名独立评估人员提取数据，通过共识讨论解决分歧。使用随机效应模型计算每个药物类别的加权平均成功率。所得数据代表44项试验，共63个研究组，4033例抑郁症患者。缓释文拉法辛的成功率为73.7%，在统计学上显著高于所研究的SSRI（61.1%）和TCA（57.9%）（P<0.001）。因此，这项对抑郁症患者随机对照研究的荟萃分析表明，缓释文拉法辛在疗效上临床优于SSRI和TCA。缓释文拉法辛的停药率普遍较低，尽管无统计学意义。
