与传统选择性5-羟色胺再摄取抑制剂及文拉法辛缓释剂相比，艾司西酞普兰治疗重度抑郁症的疗效：一项荟萃分析。
Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis.
作者信息
Kennedy Sidney H, Andersen Henning F, Lam Raymond W
机构信息
Department of Psychiatry, University of Toronto, University Health Network, Ont.
出版信息
J Psychiatry Neurosci. 2006 Mar;31(2):122-31.
OBJECTIVE
Escitalopram is the most selective of the selective serotonin reuptake inhibitor (SSRI) antidepressants. Previous studies have suggested that escitalopram is superior to citalopram in efficacy. We conducted a meta-analysis of studies in which escitalopram was compared with other antidepressants to assess the relative efficacy of these agents.
METHODS
Data from all randomized, double-blind studies in major depression in which escitalopram was compared with active controls (citalopram, fluoxetine, paroxetine, sertraline and venlafaxine XR [extended release]) were pooled. The 10 studies were conducted in both specialist settings and general practice. Patients met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), for major depressive disorder and were at least 18 years old. In all but 2 studies, patients were required to have a score of 22 or more on the Montgomery-Asberg Depression Rating Scale (MADRS). The primary outcome measure was the estimated difference in treatment effect in MADRS total score at the end of the study. Secondary outcome measures were the response to treatment (defined as a > or = 50% reduction in baseline MADRS total score) and remission rate (defined as MADRS total score < or = 12 at end of study).
RESULTS
A total of 2687 patients were included in the analyses (escitalopram n = 1345, conventional SSRIs n = 1102, venlafaxine XR n = 240). Escitalopram was superior to all comparators in overall treatment effect, with an estimated difference in treatment effect of 1.07 points (95% confidence interval [CI] 0.42-1.73, p < 0.01), and in response (odds ratio [OR] 1.29, 95% CI 1.07-1.56, p < 0.01) and remission (OR 1.21, 95% CI 1.01-1.46, p < 0.05) rates. In analysis by medication class, escitalopram was significantly superior to the SSRIs and comparable to venlafaxine, although the overall results do not necessarily reflect a significant difference between escitalopram and individual SSRIs. These results were similar in the severely depressed population (patients with baseline MADRS > or = 30). The withdrawal rate due to adverse events was 6.7% for escitalopram compared with 9.1% for the comparators (p < 0.05).
CONCLUSIONS
In this meta-analysis, escitalopram showed significant superiority in efficacy compared with the active controls.
目的
艾司西酞普兰是选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药中选择性最强的。既往研究提示艾司西酞普兰在疗效上优于西酞普兰。我们对比较艾司西酞普兰与其他抗抑郁药的研究进行了荟萃分析，以评估这些药物的相对疗效。
方法
汇总所有将艾司西酞普兰与活性对照药（西酞普兰、氟西汀、帕罗西汀、舍曲林和文拉法辛缓释剂）用于重度抑郁症的随机双盲研究数据。这10项研究在专科机构和全科医疗中均有开展。患者符合《精神疾病诊断与统计手册》第四版（DSM-IV）中重度抑郁症的标准，且年龄至少18岁。除2项研究外，所有研究要求患者在蒙哥马利-阿斯伯格抑郁评定量表（MADRS）上的得分≥22分。主要结局指标是研究结束时MADRS总分治疗效应的估计差异。次要结局指标是治疗反应（定义为基线MADRS总分降低≥50%）和缓解率（定义为研究结束时MADRS总分≤12分）。
结果
共有2687例患者纳入分析（艾司西酞普兰组n = 1345，传统SSRI组n = 1102，文拉法辛缓释剂组n = 240）。在总体治疗效应方面，艾司西酞普兰优于所有对照药，治疗效应估计差异为1.07分（95%置信区间[CI] 0.42 - 1.73，p < 0.01），在治疗反应（优势比[OR] 1.29，95% CI 1.07 - 1.56，p < 0.01）和缓解率（OR 1.21，95% CI 1.01 - 1.46，p < 0.05）方面也是如此。在按药物类别分析中，艾司西酞普兰显著优于SSRI类药物，与文拉法辛相当，尽管总体结果不一定反映艾司西酞普兰与个别SSRI类药物之间存在显著差异。在重度抑郁人群（基线MADRS≥30分的患者）中结果相似。艾司西酞普兰因不良事件的撤药率为6.7%，而对照药为9.1%（p < 0.05）。
结论
在这项荟萃分析中，与活性对照药相比，艾司西酞普兰在疗效上显示出显著优势。
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