New York Medical College, 11 Medical Park Drive, Suite 106, Pomona, NY 10970, USA.
Expert Opin Pharmacother. 2012 Aug;13(11):1545-73. doi: 10.1517/14656566.2011.626769. Epub 2011 Oct 17.
Meta-analyses are a convenient way for clinicians and researchers to review data regarding different interventions. Meta-analyses can overcome many of the limitations of individual studies, namely the power to detect differences, and help resolve the results of inconsistent studies.
This paper is a review of meta-analyses of oral atypical antipsychotics for the treatment of schizophrenia, located through PubMed and the Cochrane Database of Systematic Reviews. A total of 91 meta-analyses were identified that included efficacy outcome data for the 10 atypical antipsychotics available in the USA (11 focused on clozapine, 17 for risperidone, 8 for olanzapine, 5 for quetiapine, 3 for ziprasidone, 10 for aripiprazole, 5 for paliperidone, 1 for iloperidone, 0 for asenapine or lurasidone, and 31 others that were classified more broadly). These include Cochrane Reviews and other similarly executed reports, as well as pooled analyses meta-tagged in PubMed as a meta-analysis.
In general, there is heterogeneity among the atypical antipsychotics in terms of efficacy, with clozapine evidencing consistent superiority over typical antipsychotics, trailed behind by olanzapine and risperidone. Meta-analyses generally do not support efficacy differences between the other atypical antipsychotics compared with the older typical agents. Although this review is focused on efficacy, other considerations are also important, including the large tolerability differences among all the agents and the need to individualize medication choice based on past history of therapeutic response, past history of tolerability issues and the individual's personal values and preferences.
荟萃分析为临床医生和研究人员提供了一种方便的方法,可以对不同干预措施的数据进行回顾。荟萃分析可以克服个体研究的许多局限性,例如检测差异的能力,并有助于解决不一致研究的结果。
本文是对口服非典型抗精神病药治疗精神分裂症的荟萃分析的综述,通过 PubMed 和 Cochrane 系统评价数据库进行检索。共确定了 91 项荟萃分析,其中包括美国可用的 10 种非典型抗精神病药(11 项专注于氯氮平,17 项针对利培酮,8 项针对奥氮平,5 项针对喹硫平,3 项针对齐拉西酮,10 项针对阿立哌唑,5 项针对帕利哌酮,1 项针对依匹哌酮,0 项针对阿塞那平或鲁拉西酮,以及 31 项其他更广泛分类的药物)的疗效数据。这些包括 Cochrane 综述和其他类似执行的报告,以及在 PubMed 中标记为荟萃分析的汇总分析。
总的来说,在疗效方面,非典型抗精神病药之间存在异质性,氯氮平明显优于典型抗精神病药,其次是奥氮平和利培酮。荟萃分析通常不支持与较旧的典型药物相比,其他非典型抗精神病药之间的疗效差异。尽管这篇综述侧重于疗效,但其他考虑因素也很重要,包括所有药物之间存在较大的耐受性差异,以及根据过去的治疗反应、过去的耐受性问题和个人的个人价值观和偏好,需要个体化药物选择。