*To whom correspondence should be addressed; Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004; tel: (718) 470-4812, fax: (718) 343-1659, e-mail:
Schizophr Bull. 2013 Nov;39(6):1230-41. doi: 10.1093/schbul/sbt070. Epub 2013 May 29.
To meta-analytically assess the efficacy and tolerability of nonsteroidal anti-inflammatory drugs (NSAIDs) vs placebo in schizophrenia.
Searching PubMed, PsycINFO, ISI Web of Science, and the US National Institute of Mental Health clinical trials registry from database inception to December 31, 2012, we conducted a systematic review/meta-analysis of randomized placebo-controlled studies assessing the efficacy of adjunctive NSAIDs. Primary outcome was the change in Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcomes included change in PANSS positive and negative subscores, all-cause discontinuation, and tolerability outcomes. Random effects, pooled, standardized mean changes (Hedges' g) and risk ratios were calculated.
Across 8 studies, including 3 unpublished reports (n = 774), the mean effect size for PANSS total score was -0.236 (95% CI: -0.484 to 0.012, P = .063, I(2) = 60.6%), showing only trend-level superiority for NSAIDs over placebo. The mean effect sizes for the PANSS positive and negative scores were -0.189 (95% CI: -0.373 to -0.005, P = .044) and -0.026 (95% CI: -0.169 to 0.117, P = .72), respectively. The relative risk for all-cause discontinuation was 1.13 (95% CI: 0.794 to 1.599, P = .503). Significant superiority of NSAIDs over placebo regarding PANSS total scores was moderated by aspirin treatment (N = 2, P = .017), inpatient status (N = 4, P = .029), first-episode status (N = 2, P = .048), and (in meta-regression analyses) lower PANSS negative subscores (N = 6, P = .026).
These results indicate that adjunctive NSAIDs for schizophrenia may not benefit patients treated with first-line antipsychotics judged by PANSS total score change. NSAIDs may have benefits for positive symptoms, but the effect was minimal/small. However, due to a limited database, further controlled studies are needed, especially in first-episode patients.
系统评价非甾体抗炎药（NSAIDs）与安慰剂治疗精神分裂症的疗效和耐受性。
从数据库建立到 2012 年 12 月 31 日，检索 PubMed、PsycINFO、ISI Web of Science 和美国国立精神卫生研究所临床试验注册处，我们对评估辅助 NSAIDs 疗效的随机安慰剂对照研究进行了系统评价/荟萃分析。主要结局为阳性和阴性症状量表（PANSS）总分的变化。次要结局包括 PANSS 阳性和阴性子量表的变化、全因停药和耐受性结局。计算了随机效应、合并、标准化均数变化（Hedges'g）和风险比。
共纳入 8 项研究，包括 3 项未发表的报告（n = 774），PANSS 总分的平均效应大小为-0.236（95%CI：-0.484 至 0.012，P =.063，I² = 60.6%），仅显示 NSAIDs 优于安慰剂的趋势水平优势。PANSS 阳性和阴性评分的平均效应大小分别为-0.189（95%CI：-0.373 至 -0.005，P =.044）和-0.026（95%CI：-0.169 至 0.117，P =.72）。全因停药的相对风险为 1.13（95%CI：0.794 至 1.599，P =.503）。NSAIDs 相对于安慰剂在 PANSS 总分上的显著优势受到阿司匹林治疗（N = 2，P =.017）、住院状态（N = 4，P =.029）、首发状态（N = 2，P =.048）以及（在元回归分析中）较低的 PANSS 阴性子量表（N = 6，P =.026）的调节。
这些结果表明，辅助 NSAIDs 对精神分裂症患者可能无益，根据 PANSS 总分变化来判断，这些患者使用了一线抗精神病药物。NSAIDs 可能对阳性症状有一定的疗效，但疗效较小。然而，由于数据库有限，还需要进一步的对照研究，尤其是在首发患者中。
