Papadimitropoulou Katerina, Vossen Carla, Karabis Andreas, Donatti Christina, Kubitz Nicole
a Mapi Group , Houten , Netherlands.
b Janssen-Cilag UK , High Wycombe , United Kingdom.
Curr Med Res Opin. 2017 Apr;33(4):701-711. doi: 10.1080/03007995.2016.1277201. Epub 2017 Feb 6.
Major depressive disorder (MDD) affects about 10-15% of the general population in a lifetime. A considerable number of patients fail to achieve full symptom remission despite adequate treatment and are considered treatment resistant (TRD). The current study compared the relative efficacy and tolerability of pharmacological and somatic TRD interventions by means of a Bayesian network meta-analysis.
An electronic literature search of MEDLINE, MEDLINE In-Process, EMBASE, PsycInfo, EconLit and Cochrane Library databases for trials published between September 2003 and September 2014 was conducted. Key outcomes extracted were disease severity change from baseline, response and remission rates at various timepoints and discontinuation due to adverse events.
Of the 3876 abstracts identified, 31 publications/randomised controlled trials (RCTs) were included in the analysis; 19 RCTs investigating 13 pharmacological interventions and 12 RCTs investigating electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). The evidence synthesis investigating efficacy outcomes of TRD treatments demonstrated superior efficacy for ketamine compared to pharmacological and somatic interventions at 2 weeks after treatment initiation. At 4, 6 and 8 weeks, quetiapine augmentation (800 mg/day) and risperidone augmentation were found to be the first and second best treatments, respectively. Networks were small for response rate and remission rate outcomes at most timepoints. The most tolerable treatment was lamotrigine augmentation showing a comparable profile to placebo/sham.
This analysis revealed scarcity of long-term data on sustained remission that would allow a comparative long-term efficacy assessment. Key limitations of the analysis can be considered the search timeframe and the use of mapping formula for the depression scores.
重度抑郁症（MDD）在一生中影响着约10%-15%的普通人群。相当一部分患者尽管接受了充分治疗，但仍未能实现症状完全缓解，被认为是治疗抵抗性（TRD）患者。本研究通过贝叶斯网络荟萃分析比较了药物和躯体TRD干预措施的相对疗效和耐受性。
对MEDLINE、MEDLINE在研数据库、EMBASE、PsycInfo、EconLit和Cochrane图书馆数据库进行电子文献检索，以查找2003年9月至2014年9月期间发表的试验。提取的关键结局包括从基线开始的疾病严重程度变化、不同时间点的缓解率和缓解率以及因不良事件而停药的情况。
在识别出的3876篇摘要中，31篇出版物/随机对照试验（RCT）被纳入分析；19项RCT研究了13种药物干预措施，12项RCT研究了电休克疗法（ECT）和重复经颅磁刺激（rTMS）。对TRD治疗疗效结局的证据综合分析表明，与药物和躯体干预措施相比，氯胺酮在治疗开始后2周时疗效更佳。在4周、6周和8周时，发现喹硫平增效（800毫克/天）和利培酮增效分别是最佳和次佳治疗方法。大多数时间点的缓解率和缓解率结局的网络规模较小。耐受性最佳的治疗方法是拉莫三嗪增效，其表现与安慰剂/假手术相当。
该分析揭示了缺乏关于持续缓解的长期数据，无法进行长期疗效的比较评估。该分析的主要局限性可认为是搜索时间范围以及抑郁评分映射公式的使用。
