Lally John, Tully John, Robertson Dene, Stubbs Brendon, Gaughran Fiona, MacCabe James H
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom.
Schizophr Res. 2016 Mar;171(1-3):215-24. doi: 10.1016/j.schres.2016.01.024. Epub 2016 Jan 27.
The primary aim of this systematic review and meta-analysis was to assess the proportion of patients with Treatment Resistant Schizophrenia (TRS) that respond to ECT augmentation of clozapine (C+ECT). We searched major electronic databases from 1980 to July 2015. We conducted a random effects meta-analysis reporting the proportion of responders to C+ECT in RCTs and open-label trials. Five clinical trials met our eligibility criteria, allowing us to pool data from 71 people with TRS who underwent C+ ECT across 4 open label trials (n=32) and 1 RCT (n=39). The overall pooled proportion of response to C+ECT was 54%, (95% CI: 21.8-83.6%) with some heterogeneity evident (I(2)=69%). With data from retrospective chart reviews, case series and case reports, 192 people treated with C+ECT were included. All studies together demonstrated an overall response to C+ECT of 66% (95% CI: 57.5-74.3%) (83 out of 126 patients responded to C+ECT). The mean number of ECT treatments used to augment clozapine was 11.3. 32% of cases (20 out of 62 patients) with follow up data (range of follow up: 3-468weeks) relapsed following cessation of ECT. Adverse events were reported in 14% of identified cases (24 out of 166 patients). There is a paucity of controlled studies in the literature, with only one single blinded randomised controlled study located, and the predominance of open label trials used in the meta-analysis is a limitation. The data suggests that ECT may be an effective and safe clozapine augmentation strategy in TRS. A higher number of ECT treatments may be required than is standard for other clinical indications. Further research is needed before ECT can be included in standard TRS treatment algorithms.
本系统评价和荟萃分析的主要目的是评估难治性精神分裂症（TRS）患者中对氯氮平联合电休克治疗（C+ECT）有反应的患者比例。我们检索了1980年至2015年7月期间的主要电子数据库。我们进行了随机效应荟萃分析，报告了随机对照试验（RCT）和开放标签试验中对C+ECT有反应者的比例。五项临床试验符合我们的纳入标准，使我们能够汇总来自4项开放标签试验（n=32）和1项RCT（n=39）中71例接受C+ECT治疗的TRS患者的数据。对C+ECT有反应的总体合并比例为54%，（95%可信区间：21.8-83.6%），存在一定的异质性（I(2)=69%）。纳入了回顾性病历审查、病例系列和病例报告中的数据，共192例接受C+ECT治疗的患者。所有研究综合显示，对C+ECT的总体反应率为66%（95%可信区间：57.5-74.3%）（126例患者中有83例对C+ECT有反应）。用于增强氯氮平疗效的电休克治疗平均次数为11.3次。有随访数据（随访范围：3-468周）的病例中，32%（62例患者中有20例）在电休克治疗停止后复发。14%的已识别病例（166例患者中有24例）报告了不良事件。文献中对照研究较少，仅找到一项单盲随机对照研究，荟萃分析中使用的开放标签试验占主导地位是一个局限性。数据表明，电休克治疗可能是TRS中一种有效且安全的氯氮平增效策略。可能需要比其他临床适应证标准治疗更多次数的电休克治疗。在电休克治疗可纳入标准的TRS治疗方案之前，还需要进一步研究。
