a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Palo Alto , CA , USA.
b Global HEOR, Sunovion Pharmaceuticals Inc , Marlborough , MA , USA.
World J Biol Psychiatry. 2018 Dec;19(8):586-601. doi: 10.1080/15622975.2017.1285050. Epub 2017 Mar 7.
To assess the efficacy and tolerability of lurasidone versus other atypical antipsychotic monotherapy agents in patients with bipolar depression, using a Bayesian network meta-analysis.
Fourteen randomised clinical trials (6221 patients) of lurasidone, quetiapine (extended release and immediate release), aripiprazole, olanzapine, and ziprasidone for bipolar depression were included. Efficacy assessments included change in the Montgomery-Åsberg Depression Rating Scale (MADRS), rates of response (≥50% improvement in MADRS) and remission (MADRS ≤12 at study endpoint), and change in the Clinical Global Impressions-Bipolar Disorder-Severity (CGI-BP-S) scale. Tolerability outcomes included weight, somnolence, extrapyramidal symptoms (EPS), and all-cause discontinuation. Changes from baseline or odds ratios (OR) with 95% credible intervals (CrI) were evaluated.
Improvement in the MADRS associated with lurasidone treatment was significantly greater than placebo (-4.70, 95%CrI: -7.20, -2.21), aripiprazole (-3.62, 95%CrI: -7.04, -0.20), and ziprasidone (-3.38, 95%CrI: -6.68, -0.11), but not olanzapine (-0.15, 95%CrI: -3.12, 2.74) or quetiapine (0.10, 95%CrI: -2.68, 2.84). Results for improvement in the CGI-BP-S, and for response and remission were similar. Lurasidone was associated with less weight gain than olanzapine (-2.54 kg, 95%CrI: -3.42, -1.67) and quetiapine (-0.83kg, 95%CrI: -1.59, -0.08); and with lower rates of somnolence than quetiapine (OR: 0.33, 95%CrI: 0.11, 0.82) and ziprasidone (OR: 0.34, 95%CrI: 0.09, 0.93). No significant differences among atypical antipsychotic agents were observed in rates of discontinuation or in rates of EPS.
In this network meta-analysis, lurasidone was found to be more efficacious than aripiprazole and ziprasidone, and was associated with less weight gain than quetiapine and olanzapine and less somnolence than quetiapine and ziprasidone.
采用贝叶斯网络荟萃分析评估鲁拉西酮与其他几种非典型抗精神病药物单药治疗双相抑郁症患者的疗效和耐受性。
纳入了 14 项鲁拉西酮、喹硫平（缓释和速释）、阿立哌唑、奥氮平和齐拉西酮治疗双相抑郁症的随机临床试验（6221 例患者）。疗效评估包括蒙哥马利-阿斯伯格抑郁评定量表（MADRS）的变化、应答率（MADRS 改善≥50%）和缓解率（MADRS 在研究终点≤12）以及临床总体印象-双相障碍严重程度量表（CGI-BP-S）的变化。耐受性结局包括体重、嗜睡、锥体外系症状（EPS）和全因停药。评估了从基线变化或优势比（OR）及其 95%可信区间（CrI）。
与安慰剂相比，鲁拉西酮治疗后 MADRS 的改善明显更大（-4.70，95%CrI：-7.20，-2.21）、阿立哌唑（-3.62，95%CrI：-7.04，-0.20）和齐拉西酮（-3.38，95%CrI：-6.68，-0.11），但奥氮平（-0.15，95%CrI：-3.12，2.74）或喹硫平（0.10，95%CrI：-2.68，2.84）没有差异。CGI-BP-S 改善、应答和缓解的结果相似。与奥氮平（-2.54kg，95%CrI：-3.42，-1.67）和喹硫平（-0.83kg，95%CrI：-1.59，-0.08）相比，鲁拉西酮导致的体重增加更少；与喹硫平（OR：0.33，95%CrI：0.11，0.82）和齐拉西酮（OR：0.34，95%CrI：0.09，0.93）相比，鲁拉西酮导致的嗜睡发生率更低。在停药率或 EPS 发生率方面，几种非典型抗精神病药物之间没有观察到显著差异。
在这项网络荟萃分析中，与阿立哌唑和齐拉西酮相比，鲁拉西酮更有效，与喹硫平相比，鲁拉西酮导致的体重增加更少，与喹硫平相比，鲁拉西酮导致的嗜睡更少。
