Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
Int J Neuropsychopharmacol. 2011 Sep;14(8):1029-49. doi: 10.1017/S1461145711000885. Epub 2011 Jun 22.
The purpose of this meta-analysis was to examine the efficacy of maintenance treatments for bipolar disorder. Placebo-controlled or active comparator bipolar maintenance clinical trials of ≥6 months' duration with at least 15 patients/treatment group were identified using Medline, EMBASE, clinicaltrials.gov, and Cochrane databases (1993 to July 2010). The main outcome measure was relative risk for relapse for patients in remission. Twenty trials (5,364 patients) were identified. Overall, lithium and quetiapine were the most studied agents (eight and five trials, respectively). The majority of studies included patients who had previously responded to treatment for an acute episode. All interventions, with the exception of perphenazine+mood stabilizer, showed a relative risk for manic/mixed or depressive relapse below 1.0, although there was variation in the statistical significance of the findings vs. placebo. No monotherapy was associated with a significantly reduced risk for both manic/mixed and depressed relapse. Of the combination treatments, only quetiapine+lithium/divalproex, was associated with a significantly reduced risk vs. comparator (placebo+lithium/valproate) for relapse at both the manic/mixed and depressed poles of bipolar illness. Limitations for the analysis include differences in study durations and definitions of relapse. In conclusion, available maintenance therapies show considerable variation in efficacy. The efficacy of lithium and divalproex has been confirmed, but newer therapies, such as a number of atypical antipsychotics were also shown to be effective in bipolar disorder. Efficacy of all maintenance interventions needs to be balanced against the safety and tolerability profiles of individual agents.
本荟萃分析的目的在于检验双相情感障碍维持治疗的疗效。通过 Medline、EMBASE、clinicaltrials.gov 和 Cochrane 数据库（1993 年至 2010 年 7 月），检索到了为期至少 6 个月且至少有 15 例患者/治疗组的安慰剂对照或阳性药物对照的双相情感障碍维持临床试验。主要观察指标为缓解期患者的复发相对风险。共鉴定出 20 项试验（5364 例患者）。总体而言，锂盐和喹硫平是研究最多的药物（分别有 8 项和 5 项试验）。大多数研究纳入了先前对急性发作治疗有反应的患者。除了奋乃静+心境稳定剂之外，所有干预措施的躁狂/混合或抑郁复发的相对风险均低于 1.0，尽管与安慰剂相比，发现结果的统计学意义存在差异。没有一种单一疗法与躁狂/混合和抑郁复发的风险降低显著相关。在联合治疗中，只有喹硫平+锂盐/丙戊酸盐与对照（安慰剂+锂盐/丙戊酸盐）相比，在双相情感障碍的躁狂/混合和抑郁两极均显示出复发风险显著降低。分析的局限性包括研究持续时间和复发定义的差异。总之，现有的维持治疗方法在疗效上存在显著差异。锂盐和丙戊酸钠的疗效已得到证实，但一些新型疗法，如多种非典型抗精神病药，也显示出对双相情感障碍的疗效。所有维持干预措施的疗效都需要与个体药物的安全性和耐受性特征相平衡。
