Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
Neuroscience Department, University of Padua, Padua, Italy.
Bipolar Disord. 2018 May;20(3):195-227. doi: 10.1111/bdi.12612. Epub 2018 Feb 14.
Treatment-emergent mania (TEM) represents a common phenomenon inconsistently reported across primary studies, warranting further assessment.
A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were conducted. Major electronic databases were searched from inception to May 2017 to assess the incidence and prevalence rates and clinical features associated with manic switch among bipolar depressed patients receiving antidepressants, using meta-regression and subgroup analysis.
Overall, 10 098 depressed patients with bipolar disorder (BD) across 51 studies/arms were included in the quantitative analysis. The cumulative incidence of cases (TEM ) among 4767 patients with BD over 15 retrospective studies was 30.9% (95% confidence interval [CI] 19.6-45.0%, I = 97.9%). The cumulative incidence of TEM among 1929 patients with BD over 12 prospective open studies was 14.4% (95% CI 7.4-26.1%, I = 93.7%). The cumulative incidence of TEM among 1316 patients with BD over 20 randomized controlled trials (RCTs) was 11.8% (95% CI 8.4-16.34%, I = 73.46%). The pooled prevalence of TEM among 2086 patients with BD over four cross-sectional studies was 30.9% (95% CI 18.1-47.4%, I = 95.6%). Overall, concurrent lithium therapy predicted the lowest TEM rates. Inconsistent operational definitions of TEM were recorded, and the lack of information about age, sex, co-occurring anxiety, and other clinically relevant moderators precluded further stratification of the results.
Rates of TEM vary primarily depending on study setting, which is concordant with the high degree of heterogeneity of the included records. Forthcoming RCT studies should adopt consistent operational definitions of TEM and broaden the number of moderators, in order to contribute most effectively to the identification of clear-cut sub-phenotypes of BD and patient-tailored pharmacotherapy.
治疗诱发的躁狂（TEM）是一种在主要研究中不一致报告的常见现象，需要进一步评估。
按照系统评价和荟萃分析的首选报告项目（PRISMA）和观察性研究荟萃分析（MOOSE）指南进行系统评价和荟萃分析。从成立到 2017 年 5 月，主要电子数据库被搜索，以评估接受抗抑郁药治疗的双相抑郁患者出现躁狂转换的发生率、患病率和临床特征，使用荟萃回归和亚组分析。
共有 51 项研究/臂的 10098 名双相障碍（BD）抑郁患者纳入定量分析。15 项回顾性研究中 4767 名 BD 患者的病例累积发生率（TEM）为 30.9%（95%置信区间 [CI] 19.6-45.0%，I = 97.9%）。12 项前瞻性开放研究中 1929 名 BD 患者的 TEM 累积发生率为 14.4%（95%CI 7.4-26.1%，I = 93.7%）。20 项随机对照试验（RCT）中 1316 名 BD 患者的 TEM 累积发生率为 11.8%（95%CI 8.4-16.34%，I = 73.46%）。四项横断面研究中 2086 名 BD 患者的 TEM 总患病率为 30.9%（95%CI 18.1-47.4%，I = 95.6%）。总体而言，同时锂治疗预测 TEM 发生率最低。记录到 TEM 的不一致操作定义，并且缺乏关于年龄、性别、共病焦虑和其他临床相关调节剂的信息，排除了对结果的进一步分层。
TEM 的发生率主要取决于研究环境，这与纳入记录的高度异质性一致。即将进行的 RCT 研究应采用 TEM 的一致操作定义，并扩大调节剂的数量，以便最有效地为 BD 的明确亚表型和个体化药物治疗提供信息。
