Tandon Rajiv, Fleischhacker W Wolfgang
Office of Mental Health, Department of Children and Families, State of Florida, 1317 Winewood Boulevard, Tallahassee, FL 32399-0700, USA.
Schizophr Res. 2005 Nov 15;79(2-3):145-55. doi: 10.1016/j.schres.2005.07.025. Epub 2005 Sep 2.
Because of their broader spectrum of efficacy and lower risk of short- and long-term motor side-effects in comparison to first generation 'typical' antipsychotics (FGAs), second generation 'atypical' antipsychotics (SGAs) are rapidly becoming the standard of antipsychotic pharmacotherapy. It is unclear, however, as to how different SGAs compare in efficacy since the multitude of studies and integrative reviews seemingly provide discrepant information in this regard. To address this issue, we critically review three distinct approaches to analysis of data from randomized controlled clinical trials of the efficacy of SGAs in the treatment of schizophrenia and schizoaffective disorder: (i) comparing average improvement in symptomatology with different SGAs; (ii) comparing average improvement observed with different SGAs relative to haloperidol; and (iii) head-head trials comparing one SGA to another. We discuss the strengths and limitations of each approach with reference to the reports in which it was applied to assess comparative antipsychotic efficacy. We conclude that the most informative picture is obtained by using each of these strategies, looking at all available data, and then putting all the results together. Data thus far do not support claims of differential efficacy among SGAs with the singular exception of clozapine possibly still being the gold standard of antipsychotic efficacy in otherwise treatment-refractory schizophrenia. Dosing appears to be a critical variable in optimizing efficacy.
与第一代“典型”抗精神病药物（FGAs）相比，第二代“非典型”抗精神病药物（SGAs）具有更广泛的疗效谱，且短期和长期运动副作用风险更低，因此正迅速成为抗精神病药物治疗的标准。然而，目前尚不清楚不同的SGAs在疗效上如何比较，因为众多研究和综合评价在这方面似乎提供了相互矛盾的信息。为了解决这个问题，我们批判性地回顾了三种不同的方法，用于分析SGAs治疗精神分裂症和分裂情感性障碍疗效的随机对照临床试验数据：（i）比较不同SGAs在症状学上的平均改善情况；（ii）比较不同SGAs相对于氟哌啶醇观察到的平均改善情况；（iii）将一种SGA与另一种SGA进行头对头试验。我们参照应用这些方法评估抗精神病药物疗效比较的报告，讨论了每种方法的优缺点。我们得出结论，通过使用这些策略中的每一种，查看所有可用数据，然后将所有结果汇总在一起，可以获得最具信息量的情况。迄今为止的数据不支持SGAs之间存在疗效差异的说法，但氯氮平可能仍是治疗难治性精神分裂症抗精神病疗效的金标准这一情况除外。剂量似乎是优化疗效的关键变量。
