Belvederi Murri Martino, Guaglianone Argentina, Bugliani Michele, Calcagno Pietro, Respino Matteo, Serafini Gianluca, Innamorati Marco, Pompili Maurizio, Amore Mario
Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Largo Rosanna Benzi, 10, 16132, Genoa, Italy,
Drugs R D. 2015 Mar;15(1):45-62. doi: 10.1007/s40268-014-0078-0.
Neuroleptic malignant syndrome (NMS) is a rare, severe, idiosyncratic adverse reaction to antipsychotics. Second-generation antipsychotics (SGAs) were originally assumed to be free from the risk of causing NMS, however several cases of NMS induced by SGAs (SGA-NMS) have been reported.
The aim of this study was to systematically review available studies and case reports on SGA-NMS and compare the presentation of NMS induced by different SGAs.
Citations were retrieved from PubMed up to November 2013, and from reference lists of relevant citations.
Eligibility criteria included (a) primary studies reporting data on NMS, with at least 50 % of the sample receiving SGAs; or (b) case reports and case reviews reporting on NMS induced by SGA monotherapy, excluding those due to antipsychotic withdrawal.
A standardized method for data extraction and coding was developed for the analysis of eligible case reports.
Six primary studies and 186 individual cases of NMS induced by SGAs were included. Primary studies suggest that SGA-NMS is characterized by lower incidence, lower clinical severity, and less frequent lethal outcome than NMS induced by first-generation antipsychotics. Systematic analysis of case reports suggests that even the most recently marketed antipsychotics are not free from the risk of inducing NMS. Furthermore, clozapine-, aripiprazole- and amisulpride-induced NMS can present with atypical features more frequently than other SGA-NMS, i.e. displaying less intense extrapyramidal symptoms or high fever.
Case reports report non-systematic data, therefore analyses may be subject to bias.
Clinicians should be aware that NMS is virtually associated with all antipsychotics, including those most recently marketed. Although apparently less severe than NMS induced by older antipsychotics, SGA-NMS still represent a relevant clinical issue.
抗精神病药恶性综合征（NMS）是一种罕见、严重、特异质性的抗精神病药不良反应。第二代抗精神病药（SGA）最初被认为无引发NMS的风险，然而，已有数例由SGA诱发的NMS（SGA-NMS）病例报告。
本研究旨在系统回顾关于SGA-NMS的现有研究和病例报告，并比较不同SGA诱发的NMS的表现。
截至2013年11月从PubMed检索文献，并从相关文献的参考文献列表中获取文献。
纳入标准包括：（a）报告NMS数据的原始研究，样本中至少50%接受SGA治疗；或（b）报告SGA单药治疗诱发NMS的病例报告和病例综述，排除因停用抗精神病药导致的病例。
开发了一种标准化的数据提取和编码方法，用于分析符合条件的病例报告。
纳入6项原始研究和186例由SGA诱发的NMS个体病例。原始研究表明，与第一代抗精神病药诱发的NMS相比，SGA-NMS的特点是发病率较低、临床严重程度较低、致死结局较少见。对病例报告的系统分析表明，即使是最新上市的抗精神病药也有诱发NMS的风险。此外，氯氮平、阿立哌唑和氨磺必利诱发的NMS比其他SGA-NMS更常表现出非典型特征，即锥体外系症状较轻或发热程度较低。
病例报告所报告的数据不系统，因此分析可能存在偏倚。
临床医生应意识到，NMS几乎与所有抗精神病药相关，包括那些最新上市的药物。尽管SGA-NMS显然比老一代抗精神病药诱发的NMS症状较轻，但它仍然是一个重要的临床问题。
