Department of Neuroscience,Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona,Verona,Italy.
Epidemiol Psychiatr Sci. 2017 Oct;26(5):462-465. doi: 10.1017/S2045796017000245. Epub 2017 Jun 5.
In the treatment of resistant schizophrenia, a number of meta-analyses attempted to quantify the efficacy and tolerability of antipsychotic (AP) polypharmacy v. monotherapy with contradictory results. Recently, a systematic review and meta-analysis of randomised controlled trials investigated the efficacy and tolerability of AP combination v. monotherapy in schizophrenia. It included 31 studies: 21 double-blind (considered high-quality studies) and 10 open-label (considered low-quality studies). The meta-analysis showed that, overall, the combination of two APs was more effective than monotherapy in terms of symptom reduction (standardised mean difference (SMD) = -0.53, 95% confidence interval (CI) -0.87 to -0.19); however, this result was confirmed only in the subgroup of low-quality studies. Negative symptoms improved when combining a D2 antagonist with a D2 partial agonist (SMD = -0.41, 95% CI -0.79 to -0.03) both in double-blind and open-label studies. In the present commentary, the results of this systematic review are critically discussed in terms of their clinical and research implications.
在治疗耐药性精神分裂症方面，多项荟萃分析试图量化抗精神病药物（AP）联合用药与单一疗法相比的疗效和耐受性，但结果存在矛盾。最近，一项针对随机对照试验的系统评价和荟萃分析研究了精神分裂症中 AP 联合用药与单一疗法的疗效和耐受性。该研究共纳入 31 项研究：21 项双盲（被认为是高质量研究）和 10 项开放标签（被认为是低质量研究）。荟萃分析显示，总的来说，两种 AP 联合用药在症状缓解方面比单一疗法更有效（标准化均数差（SMD）=-0.53，95%置信区间（CI）-0.87 至 -0.19）；然而，这一结果仅在低质量研究的亚组中得到证实。在双盲和开放标签研究中，当将 D2 拮抗剂与 D2 部分激动剂联合使用时，阴性症状得到改善（SMD=-0.41，95%CI-0.79 至 -0.03）。在本评论中，将从临床和研究意义的角度对这项系统评价的结果进行批判性讨论。
