Taylor D M, Smith L
Pharmacy Department, South London and Maudsley NHS Foundation Trust, UK.
Acta Psychiatr Scand. 2009 Jun;119(6):419-25. doi: 10.1111/j.1600-0447.2009.01367.x. Epub 2009 Feb 25.
Inadequate response to clozapine treatment is frequently encountered in practice and augmentation strategies have been developed in an attempt to improve response. Aims of the study were to evaluate the therapeutic effect of adding an antipsychotic drug to clozapine treatment.
Meta-analysis of randomized, placebo-controlled studies of antipsychotic augmentation of clozapine treatment.
Ten studies (including 522 subjects) met inclusion criteria. Antipsychotic augmentation showed significant benefit over the addition of placebo on only one outcome measure examined [mean effect size for rating scale score (BPRS/PANSS) -0.180, 95% CI -0.356 to -0.004]. Antipsychotic augmentation showed no advantage on withdrawals from trials (risk ratio 1.261, 95% CI 0.679-2.345) or on CGI scores (effect size -0.661, 95% CI -1.475 to 0.151). Duration of study was not associated with outcome (P = 0.95). There was no evidence of publication bias.
In studies lasting up to 16 weeks, the addition of an antipsychotic to clozapine treatment has marginal therapeutic benefit. Longer and larger trials are necessary to demonstrate the precise therapeutic utility of antipsychotic co-therapy with clozapine.
在实践中经常遇到对氯氮平治疗反应不足的情况，因此已制定增效策略以试图改善反应。本研究的目的是评估在氯氮平治疗中添加一种抗精神病药物的治疗效果。
对氯氮平治疗增效的抗精神病药物进行随机、安慰剂对照研究的荟萃分析。
十项研究（包括522名受试者）符合纳入标准。在仅一项检查的结局指标上，抗精神病药物增效比添加安慰剂显示出显著益处[评定量表评分（BPRS/PANSS）的平均效应量为-0.180，95%可信区间为-0.356至-0.004]。抗精神病药物增效在试验退出率（风险比1.261，95%可信区间为0.679 - 2.345）或CGI评分（效应量-0.661，95%可信区间为-1.475至0.151）方面没有优势。研究持续时间与结局无关（P = 0.95）。没有发表偏倚的证据。
在长达16周的研究中，在氯氮平治疗中添加抗精神病药物具有边际治疗益处。需要进行更长时间和更大规模的试验来证明抗精神病药物与氯氮平联合治疗的确切治疗效用。
