Departments of Psychological Medicine and Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
J Affect Disord. 2011 Nov;134(1-3):14-9. doi: 10.1016/j.jad.2010.11.009. Epub 2010 Dec 9.
All treatment guidelines for acute mania recommend monotherapy with either mood stabilizers (MS) or antipsychotics. The objective of this analysis was to compare the efficacy and acceptability of both drug classes in an expanded set of clinical trials in acute mania.
Randomized double-blind trials comparing MS vs second generation antipsychotics (SGA) in acute mania were identified in a systematic literature search. Change in mania rating scale, responder rates and dropout rates were compared by treatment assignment using Review Manager version 5.0.
Nine studies totaling 1631 patients that compared the MS lithium or valproate against a number of SGAs, and which reported one or more analysis endpoints were identified. Statistically significant advantages were noted in favour of SGA over MS for standardized mean difference (SMD) for change in mania scores (-0.22 [95% CI -0.33 to -0.11]; p < 0.0001), responder rate risk difference (7% [95% CI 1% to 13%]; p = 0.02), and dropout risk difference (-5% [95% CI -10% to -1%]; p = 0.02). This change in SMD for mania scores is equivalent to a 2.5-3 point difference in Young Mania Rating Scale score. Similar trends for SMD were noted when comparing subgroups of lithium and valproate studies against SGAs.
Over half the included studies included olanzapine, and the applicability of these findings, especially to first generation antipsychotic drugs, requires confirmation. This analysis could not assess the relative efficacy of combined MS/SGA vs individual monotherapies.
In acute mania, monotherapy with SGAs demonstrates statistically significant advantages over MS in terms of both efficacy and acceptability, and may be preferable for initial choice of treatment.
所有治疗躁狂症的指南都建议采用心境稳定剂（MS）或抗精神病药物进行单一疗法。本分析的目的是在更广泛的急性躁狂症临床试验中比较这两类药物的疗效和可接受性。
通过系统文献检索，确定了比较 MS 与第二代抗精神病药（SGA）在急性躁狂症中的随机双盲试验。使用 Review Manager 版本 5.0 根据治疗分配比较了躁狂量表评分的变化、应答率和退出率。
共确定了 9 项研究，总计 1631 名患者，这些研究比较了 MS 锂盐或丙戊酸盐与多种 SGA 的疗效，并报告了一个或多个分析终点。与 MS 相比，SGA 在躁狂评分变化的标准化均数差（SMD）（-0.22 [95%CI -0.33 至 -0.11]；p < 0.0001）、应答率风险差异（7% [95%CI 1%至 13%]；p = 0.02）和退出风险差异（-5% [95%CI -10%至 -1%]；p = 0.02）方面具有统计学优势。躁狂评分的 SMD 变化相当于 Young Mania Rating Scale 评分的 2.5-3 分差异。当比较锂盐和丙戊酸盐研究的亚组与 SGA 时，SMD 也有类似的趋势。
超过一半的纳入研究包括奥氮平，这些发现的适用性，特别是对第一代抗精神病药物的适用性，需要进一步证实。本分析无法评估联合 MS/SGA 与单一疗法的相对疗效。
在急性躁狂症中，与 MS 相比，SGA 单一疗法在疗效和可接受性方面具有统计学优势，可能是初始治疗的首选。
