Tan Lin, Tan Lan, Wang Hui-Fu, Wang Jun, Tan Chen-Chen, Tan Meng-Shan, Meng Xiang-Fei, Wang Chong, Yu Jin-Tai
College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, 266000 China.
College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, 266000 China ; Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China ; Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, 210000 China.
Alzheimers Res Ther. 2015 Apr 20;7(1):20. doi: 10.1186/s13195-015-0102-9. eCollection 2015.
A wide variety of atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone and clozapine) are widely used in the management of neuropsychiatric symptoms, which are commonly seen in dementia, but results from randomised controlled trials (RCTs) on the efficacy and safety of these agents are conflicting. We aimed to quantify the efficacy and safety of atypical antipsychotic drugs on neuropsychiatric symptoms in dementia patients.
PubMed, EMBASE, the Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews for reports published before August 2014 were searched for eligible randomized controlled trials of atypical antipsychotic drugs therapy in patients with psychotic symptoms of dementia. Two reviewers independently assessed the quality of the trials and extracted information.
Overall, 23 relevant RCTs with 5,819 participants were identified. This meta-analysis demonstrated a significant efficacy of atypical antipsychotics on psychiatric symptoms and cognitive functions compared to placebo. In the meta-analysis, the weighted mean differences (WMDs) in change scores for psychiatric symptoms were in favor of aripiprazole (-4.4, 95% confidence interval (CI) - 7.04 to -1.77) and risperidone (-1.48, 95% CI -2.35 to -0.61) compared to placebo. In cognitive effects, WMDs in change scores for the Clinical Global Impression-Change (CGI-C) were in favor of aripiprazole, risperidone, olanzapine and quetiapine which ranged from a -0.30 points mean difference (95% CI:-0.59 to -0.01) in the aripiprazole trials to -0.43 (95% CI:-0.62 to -0.25) in the risperidone group. Patients receiving atypical antipsychotics showed no difference in risk for injuries or falls (P > 0.05), significantly higher risks (P < 0.05) for somnolence, urinary tract infection, edema and abnormal gait. However, there was no significant evidence for death reported.
Aripiprazole and risperidone are able to improve psychiatric symptoms and slow decline in cognition function at average 12 weeks in patients with neuropsychiatric symptoms of dementia. However, high adverse events may offset the efficacy of atypical antipsychotics in dementia.
多种非典型抗精神病药物（利培酮、奥氮平、喹硫平、阿立哌唑、齐拉西酮和氯氮平）被广泛用于治疗痴呆症中常见的神经精神症状，但关于这些药物疗效和安全性的随机对照试验（RCT）结果相互矛盾。我们旨在量化非典型抗精神病药物对痴呆症患者神经精神症状的疗效和安全性。
检索了PubMed、EMBASE、Cochrane对照试验注册库和Cochrane系统评价数据库，以查找2014年8月之前发表的关于非典型抗精神病药物治疗痴呆症精神病症状患者的合格随机对照试验。两名评价员独立评估试验质量并提取信息。
总体而言，共确定了23项相关的随机对照试验，涉及5819名参与者。该荟萃分析表明，与安慰剂相比，非典型抗精神病药物对精神症状和认知功能具有显著疗效。在荟萃分析中，与安慰剂相比，阿立哌唑（加权平均差（WMD）为-4.4，95%置信区间（CI）为-7.04至-1.77）和利培酮（WMD为-1.48，95%CI为-2.35至-0.61）在精神症状变化评分方面更具优势。在认知效果方面，临床总体印象变化（CGI-C）评分的WMD有利于阿立哌唑、利培酮、奥氮平和喹硫平，在阿立哌唑试验中平均差异为-0.30分（95%CI：-0.59至-0.01），在利培酮组中为-0.43（95%CI：-0.62至-0.25）。接受非典型抗精神病药物治疗的患者在受伤或跌倒风险方面无差异（P>0.05），但在嗜睡、尿路感染、水肿和异常步态方面风险显著更高（P<0.05）。然而，没有关于死亡的显著证据报道。
阿立哌唑和利培酮能够改善痴呆症神经精神症状患者的精神症状，并在平均12周时减缓认知功能衰退。然而，高不良事件发生率可能会抵消非典型抗精神病药物在痴呆症中的疗效。
