Ehret M, Sobieraj D M
Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA.
Int J Clin Pract. 2014 Feb;68(2):255-61. doi: 10.1111/ijcp.12268. Epub 2013 Dec 22.
To conduct a systematic review and meta-analysis evaluating the efficacy and safety of antidepressant medications for the prevention of interferon-alpha (INF-α)-associated depression in patients with chronic hepatitis C virus (HCV).
Medline, Cochrane Central and PsycInfo from inception to September 2012, without limitations using terms describing hepatitis C and the individual drug names.
We reviewed 132 citations for inclusion using the following criteria: randomised controlled trials in patients with chronic HCV initiating INF-α comparing prophylactic use of an antidepressant vs. placebo and reporting at least one outcome of interest [depression, completion of antiviral therapy, sustained virologic response (SVR), and serious adverse events and bleeding].
Trial characteristics, assessment of risk of bias and data needed for analyses were extracted by two independent investigators using a standard extraction form. Disagreements were reviewed by a third investigator.
A DerSimonian and Laird random-effects model was used for analysis. Heterogeneity and publication bias were evaluated where applicable. Of the seven included trials, the risk of bias was low in four and unclear in the remaining three. All trials evaluated selective serotonin reuptake inhibitors (SSRIs). Prophylactic use of a SSRI significantly reduced the risk of depression by 41% compared with placebo [RR, relative risk 0.59 (0.37-0.93)]. The impact of SSRIs on completion of antiviral therapy, SVR and serious adverse events was not found to be significant.
SSRIs prevent depression in patients with HCV treated with INF-α therapy. The impact of SSRIs on completion of antiviral therapy or on the development of adverse events is less clear.
进行一项系统评价和荟萃分析，评估抗抑郁药物预防慢性丙型肝炎病毒（HCV）患者中干扰素-α（INF-α）相关抑郁的疗效和安全性。
检索自起始至2012年9月的Medline、Cochrane中心数据库和PsycInfo，使用描述丙型肝炎和各药物名称的术语，无检索限制。
我们根据以下标准对132篇引文进行纳入审查：针对开始使用INF-α的慢性HCV患者的随机对照试验，比较抗抑郁药物与安慰剂的预防性使用，并报告至少一项感兴趣的结局[抑郁、抗病毒治疗完成情况、持续病毒学应答（SVR）以及严重不良事件和出血]。
两名独立研究人员使用标准提取表格提取试验特征、偏倚风险评估和分析所需数据。分歧由第三名研究人员审查。
采用DerSimonian和Laird随机效应模型进行分析。在适用的情况下评估异质性和发表偏倚。纳入的七项试验中，四项的偏倚风险较低，其余三项不明确。所有试验均评估了选择性5-羟色胺再摄取抑制剂（SSRI）。与安慰剂相比，预防性使用SSRI可使抑郁风险显著降低41%[RR，相对风险0.59（0.37 - 0.93）]。未发现SSRI对抗病毒治疗完成情况、SVR和严重不良事件有显著影响。
SSRI可预防接受INF-α治疗的HCV患者发生抑郁。SSRI对抗病毒治疗完成情况或不良事件发生的影响尚不清楚。
