Li Yuan-Yuan, Zhang Yun-Shu, Wang Jian, Li Ke-Qing, Wang Hong-Ying
Department of Psychosomatic Disorders, the Sixth People's Hospital of Hebei Province, Baoding, Hebei 071000, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2016 Dec 20;38(6):666-678. doi: 10.3881/j.issn.1000-503X.2016.06.008.
Objective To systematically evaluate the efficacy of clozapine combined with other antipsychotic drugs in the treatment of refractory schizophrenia. Methods We searched Medline, EMBASE, and China Biology Medicine databases in both English and Chinese for randomized controlled trials, quasi-randomization controlled trials, and clinical controlled trials concerning the combinations of clozapine with other antipsychotic drugs for refractory schizophrenia. Quality assessment and data extraction were conducted with the Cochrane collaboration's RevMan 5.3 software. Results Totally 47 trials met the inclusion criteria, in which clozapine was combined with risperidone, aripiprazole, sulpiride, ziprasidone, modified electroconvulsive therapy, valproate, or lithium carbonate, respectively. Analysis showed that most combination strategies were superior to clozapoine alone (P<0.05), except for the combination with lithium carbonate(8 weeks: RR=1.27, 95%CI=0.82-1.97,P=0.28; 12 weeks: RR=1.53, 95% CI=0.45-5.13, P=0.49). Conclusion Reasonable combination of clozapine with other drugs may improve the therapeutic effectiveness and reduce adverse reactions and thus can be effectively used for treating refractory schizophrenia.
目的 系统评价氯氮平联合其他抗精神病药物治疗难治性精神分裂症的疗效。方法 检索Medline、EMBASE及中国生物医学数据库（中英文版），查找关于氯氮平联合其他抗精神病药物治疗难治性精神分裂症的随机对照试验、半随机对照试验及临床对照试验。采用Cochrane协作网的RevMan 5.3软件进行质量评估和数据提取。结果 共47项试验符合纳入标准，其中氯氮平分别与利培酮、阿立哌唑、舒必利、齐拉西酮、改良电休克治疗、丙戊酸盐或碳酸锂联合应用。分析显示，除与碳酸锂联合外（8周：RR = 1.27，95%CI = 0.82 - 1.97，P = 0.28；12周：RR = 1.53，95%CI = 0.45 - 5.13，P = 0.49），大多数联合策略优于单用氯氮平（P < 0.05）。结论 氯氮平与其他药物合理联合可提高治疗效果，减少不良反应，从而可有效用于治疗难治性精神分裂症。
