Dan Siskind, MBBS, PhD, Metro South Addiction and Mental Health Services, Brisbane, and University of Queensland School of Medicine, Brisbane; Lara McCartney, MBBS, Royal Melbourne Hospital, Melbourne; Romi Goldschlager, MBBS, St Vincent's Hospital, Melbourne; Steve Kisely, MD, PhD, Metro South Addiction and Mental Health Services, Brisbane, University of Queensland School of Medicine, Brisbane, and Griffith Health Institute, Brisbane, Australia
Dan Siskind, MBBS, PhD, Metro South Addiction and Mental Health Services, Brisbane, and University of Queensland School of Medicine, Brisbane; Lara McCartney, MBBS, Royal Melbourne Hospital, Melbourne; Romi Goldschlager, MBBS, St Vincent's Hospital, Melbourne; Steve Kisely, MD, PhD, Metro South Addiction and Mental Health Services, Brisbane, University of Queensland School of Medicine, Brisbane, and Griffith Health Institute, Brisbane, Australia.
Br J Psychiatry. 2016 Nov;209(5):385-392. doi: 10.1192/bjp.bp.115.177261. Epub 2016 Jul 7.
Although clozapine is the 'gold standard' for treatment-refractory schizophrenia, meta-analyses of clozapine for this condition are lacking.
We conducted a systematic review and meta-analysis of clozapine treatment for people with treatment-refractory schizophrenia.
We searched the Cochrane Schizophrenia Group's trial register, PubMed and EMBASE and hand-searched key papers for randomised controlled trials of clozapine for treatment-refractory schizophrenia.
Twenty-one papers with 25 comparisons were included. The number needed to treat was 9. Clozapine was superior for positive symptoms in both the short and long term. In the short term only clozapine was superior for total and negative symptoms, with higher response rates. Both funding source and dosage affected results. Higher baseline psychosis scores predicted better outcomes for clozapine in a meta-regression.
Clozapine is superior for treatment-refractory disorder but if there is no response by 6 months medications with lower adverse reactions should be considered.
氯氮平虽然是治疗难治性精神分裂症的“金标准”，但目前缺乏针对该疾病的氯氮平荟萃分析。
我们对氯氮平治疗难治性精神分裂症的疗效进行了系统评价和荟萃分析。
我们检索了 Cochrane 精神分裂症组试验登记处、PubMed 和 EMBASE，并对关键论文进行了手工检索，以查找氯氮平治疗难治性精神分裂症的随机对照试验。
纳入 21 篇文献，共计 25 项比较。需要治疗的人数为 9 人。氯氮平在短期和长期内对阳性症状均有优势。仅在短期治疗中，氯氮平对总症状和阴性症状更优，且应答率更高。资金来源和剂量均影响了结果。元回归分析显示，较高的基线精神病评分预示着氯氮平有更好的治疗效果。
氯氮平对治疗难治性疾病有效，但如果在 6 个月内没有反应，应考虑使用不良反应较低的药物。
