Williams John W, Ranney Leah, Morgan Laura C, Whitener Lynn
Center for Health Services Research in Primary Care, Durham VAMC and Center for Clinical Health Policy Research, Duke University, Durham, NC 27705, USA.
Gen Hosp Psychiatry. 2009 May-Jun;31(3):279-87. doi: 10.1016/j.genhosppsych.2009.02.006. Epub 2009 Apr 5.
Despite the lack of randomized controlled trials (RCTs), gabapentin use increased rapidly in the 1990s for mental health conditions. Subsequent RCTs did not demonstrate efficacy for bipolar disorder (BD). We examined the characteristics of review articles to determine their potential role in the growth of gabapentin for BD.
We searched MEDLINE, the International Pharmaceutical Abstracts and LexisNexis for review articles or commentaries examining the role of gabapentin for BD. Electronic searches were supplemented by manual searches of reference lists. Articles were abstracted for the types of evidence cited, source of evidence, the proportion of available RCTs cited and narrative blurbs discussing the role of gabapentin for BD. Review articles were classified as narrative versus systematic and positive, neutral or negative regarding the role of gabapentin in BD.
We included 27 review articles published between 1998 and 2008, but no commentaries met eligibility criteria. Most did not describe potential conflicts of interest or a funding source, and the 3 systematic reviews were of low quality. The 11 reviews published prior to the first RCT of gabapentin for BD cited uncontrolled trials or case series (n=9), basic science (n=6), chart reviews (n=3) or unpublished RCTs (n=2). Six recommended gabapentin, 3 were neutral and 2 were negative. The 16 articles published after the first gabapentin RCT continued to cite uncontrolled trials and basic science; only 5 cited all the available RCTs. However, more of these reviews (n=10) reached negative conclusions about the role of gabapentin for BD.
Narrative and low-quality systematic reviews, principally those published prior to RCTs, may have contributed to the growth of gabapentin use for BD. High-quality systematic reviews are needed to inform clinicians and policymakers about the effectiveness of new treatments.
尽管缺乏随机对照试验（RCT），加巴喷丁在20世纪90年代用于精神健康状况的使用仍迅速增加。随后的随机对照试验并未证明其对双相情感障碍（BD）有效。我们研究了综述文章的特征，以确定它们在加巴喷丁用于双相情感障碍增长过程中的潜在作用。
我们在医学文献数据库（MEDLINE）、国际药学文摘数据库和律商联讯数据库中检索关于探讨加巴喷丁对双相情感障碍作用的综述文章或评论。电子检索辅以对参考文献列表的手动检索。提取文章中引用的证据类型、证据来源、引用的可用随机对照试验比例以及讨论加巴喷丁对双相情感障碍作用的叙述性短文。综述文章根据其叙述性与系统性以及对加巴喷丁在双相情感障碍中作用的态度分为阳性、中性或阴性。
我们纳入了1998年至2008年发表的27篇综述文章，但没有评论符合纳入标准。大多数文章未描述潜在的利益冲突或资金来源，且3篇系统性综述质量较低。在加巴喷丁用于双相情感障碍的首个随机对照试验之前发表的11篇综述引用了非对照试验或病例系列（n = 9）、基础科学（n = 6）、病历回顾（n = 3）或未发表的随机对照试验（n = 2）。6篇推荐加巴喷丁，3篇持中性态度，2篇持否定态度。在加巴喷丁首个随机对照试验之后发表的16篇文章继续引用非对照试验和基础科学；只有5篇引用了所有可用的随机对照试验。然而，这些综述中更多（n = 10）对加巴喷丁在双相情感障碍中的作用得出了否定结论。
叙述性和低质量的系统性综述，主要是那些在随机对照试验之前发表的，可能促成了加巴喷丁用于双相情感障碍的使用增长。需要高质量的系统性综述来告知临床医生和政策制定者新治疗方法的有效性。
