Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY; School of Medicine, St. George's University, St. George's, Grenada.
Am J Med. 2013 Nov;126(11):1017.e11-8. doi: 10.1016/j.amjmed.2013.02.037. Epub 2013 Aug 29.
Studies have demonstrated the success of augmentation of antidepressant therapy with nonsteroidal anti-inflammatory drugs (NSAID) in decreasing depressive symptoms; however, little is known about the benefit of NSAID therapy on depressive symptoms.
This study pooled data from 5 postapproval trials, each trial a 6-week, multicenter, randomized, double-blinded, placebo-controlled, active-comparator, parallel-group study in subjects with active osteoarthritis. Subjects were randomized to placebo group, ibuprofen 800 mg 3 times daily or naproxen 500 mg twice daily group, or Celebrex 200 mg daily group. Apart from different ethnicities enrolled, these trials had identical study designs. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Outcomes measured were change in PHQ-9 score after 6 weeks of NSAID therapy and change in classification of depression with a PHQ-9 score ≥10 as a marker of depression.
There were 1497 patients included. Median PHQ-9 score was similar in all 3 groups at baseline and after 6 weeks of treatment. Multivariable regression analysis demonstrated a detectable effect in lowering PHQ-9 score in the ibuprofen or naproxen group (-0.31) and Celebrex group (-0.61) (P = .0390). With respect to the change in classification of depression, logistic regression analysis demonstrated a trend towards significant treatment effect of all NSAIDs compared with placebo.
Our analysis of pooled data from 5 postapproval trials shows that NSAID usage demonstrates a trend towards reduction of depression symptoms in patients with osteoarthritis based upon PHQ-9 scores. Future clinical trials should investigate this association with maximum dosage of drugs, increased treatment duration, and monitoring of social and environmental changes.
研究表明，在抗抑郁治疗中加入非甾体抗炎药（NSAID）可成功减轻抑郁症状；然而，关于 NSAID 治疗对抑郁症状的益处知之甚少。
本研究汇总了 5 项上市后试验的数据，每项试验均为为期 6 周、多中心、随机、双盲、安慰剂对照、活性对照、平行组研究，对象为患有活动性骨关节炎的患者。患者被随机分配至安慰剂组、布洛芬 800mg 每日 3 次或萘普生 500mg 每日 2 次组，或西乐葆 200mg 每日 1 次组。除了入组的不同种族外，这些试验具有相同的研究设计。使用患者健康问卷-9（PHQ-9）评估抑郁情况。测量的结果是 6 周 NSAID 治疗后 PHQ-9 评分的变化以及 PHQ-9 评分≥10 作为抑郁标志物的抑郁分类变化。
共纳入 1497 例患者。所有 3 组患者的基线和治疗 6 周后的 PHQ-9 评分中位数相似。多变量回归分析显示，布洛芬或萘普生组（-0.31）和西乐葆组（-0.61）降低 PHQ-9 评分具有可检测的效果（P=0.0390）。关于抑郁分类的变化，逻辑回归分析显示，与安慰剂相比，所有 NSAID 的治疗效果均呈显著趋势。
我们对 5 项上市后试验的汇总数据分析表明，基于 PHQ-9 评分，NSAID 的使用显示出在骨关节炎患者中减轻抑郁症状的趋势。未来的临床试验应使用最大剂量的药物、增加治疗持续时间和监测社会和环境变化来研究这种关联。
