Okuyama Yuji, Oya Kazuto, Matsunaga Shinji, Kishi Taro, Iwata Nakao
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan.
Neuropsychiatr Dis Treat. 2016 Dec 15;12:3221-3236. doi: 10.2147/NDT.S125367. eCollection 2016.
This study aimed to perform a comprehensive meta-analysis of topiramate-augmentation therapy in patients with schizophrenia receiving antipsychotic agents. Data published up to June 20, 2016 were obtained from the PubMed, PsycINFO, and Cochrane Library databases. Twelve randomized controlled trials comparing topiramate to placebo or antipsychotic only were included (n=676 patients). The primary outcome was change in overall symptoms. Relative risk (RR) and standardized mean difference (SMD), along with 95% confidence intervals, were calculated using random effects model for each outcome. Topiramate-augmentation therapy was superior to the control for decreasing overall symptoms (SMD -0.55, 95% confidence interval -0.86 to -0.24; =0.001; =55%, eight comparisons, n=380), positive symptoms (SMD -0.4), negative symptoms (SMD -0.47), and Positive and Negative Syndrome Scale general subscale scores (SMD -0.67). Furthermore, topiramate-augmentation therapy decreased weight (SMD -0.69) and body mass index (SMD -0.95) compared with the control. Topiramate was similar to the control with respect to discontinuation due to all causes (RR 1.19), inefficacy (RR 1.71), and adverse events (RR 1.09). Topiramate was associated with higher incidence of paresthesia (RR 2.67) and attention difficulty (RR 8.97) compared with the control. Our results seemed to suggest that topiramate-augmentation therapy improves the psychopathology of schizophrenia with good tolerability and has the additional advantage of weight maintenance. However, because there were some limitations (numbers of studies and patients included in the meta-analysis were small, some studies used completer analysis, Chinese studies were included in the meta-analysis, and studies that had a risk of bias were included in the meta-analysis) in this study, we cannot apply the results of this study in daily clinical practice.
本研究旨在对接受抗精神病药物治疗的精神分裂症患者使用托吡酯增效疗法进行全面的荟萃分析。截至2016年6月20日发表的数据来自PubMed、PsycINFO和Cochrane图书馆数据库。纳入了12项比较托吡酯与安慰剂或仅抗精神病药物的随机对照试验（n = 676例患者）。主要结局是总体症状的变化。使用随机效应模型为每个结局计算相对风险（RR）和标准化均数差（SMD）以及95%置信区间。托吡酯增效疗法在减轻总体症状方面优于对照组（SMD -0.55，95%置信区间 -0.86至 -0.24；P = 0.001；I² = 55%，八项比较，n = 380）、阳性症状（SMD -0.4）、阴性症状（SMD -0.47）以及阳性和阴性症状量表总体子量表评分（SMD -0.67）。此外，与对照组相比，托吡酯增效疗法减轻了体重（SMD -0.69）和体重指数（SMD -0.95）。在因各种原因停药（RR 1.19）、无效（RR 1.71）和不良事件（RR 1.09）方面，托吡酯与对照组相似。与对照组相比，托吡酯与感觉异常发生率较高（RR 2.67）和注意力困难发生率较高（RR 8.97）相关。我们的结果似乎表明，托吡酯增效疗法可改善精神分裂症的精神病理学，耐受性良好，并且具有维持体重的额外优势。然而，由于本研究存在一些局限性（荟萃分析中纳入的研究和患者数量较少，一些研究采用了完成者分析，荟萃分析中纳入了中文研究，并且纳入了存在偏倚风险的研究），我们不能将本研究结果应用于日常临床实践。
