Luan Shuxin, Wan Hongquan, Zhang Lei, Zhao Hua
Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun, China.
Department of Mental Health, The First Hospital of Jilin University, Changchun, China.
Neuropsychiatr Dis Treat. 2018 Feb 8;14:467-477. doi: 10.2147/NDT.S156619. eCollection 2018.
Treatment-resistant depression (TRD) is common and potentially life-threatening in adults, and the benefits and risks of adjunctive aripiprazole in these patients remain controversial. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy, acceptability, safety, and quality of life of adjunctive aripiprazole in patients with TRD.
RCTs published in PubMed, Web of Science, and Embase were systematically reviewed to evaluate the efficacy and safety profiles of TRD patients who were treated with adjunctive aripiprazole. The main outcome measures included response rate, remission rate, changes from baseline in Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impression-severity (CGI-S), Clinical Global Impression-improvement (CGI-I), 17-Item Hamilton Rating Scale for Depression (HAM-D17), Sheehan Disability scale (SDS), and Inventory of Depressive Symptomatology Self-Report Scale (IDS-SR), discontinuation due to adverse events, and adverse events. Risk ratio (RR) or weight mean difference with 95% confidence intervals (CIs) were pooled using a fixed-effects or random-effects model according to the heterogeneity among studies.
A total of 8 RCTs involving 2,260 patients were included in this meta-analysis. Adjunctive aripiprazole was associated with a significantly higher remission rate (RR =1.64, 95% CI: 1.42 to 1.89; <0.001) and response rate (RR =1.45, 95% CI: 1.13 to 1.87; =0.004) than other treatments. Moreover, adjunctive aripiprazole had greater changes in MADRS score, CGI-S score, CGI-I score, HAM-D17 score, SDS score, and IDS-SR score. There were more patients treated with adjunctive aripiprazole who discontinued their treatments due to adverse events. The incidence of adverse events was significantly higher in the adjunctive aripiprazole group than in other treatment groups.
The adjunctive aripiprazole showed benefits in improving the response rate, remission rate, and the quality of life in patients with TRD. However, clinicians should interpret these findings with caution due to the evidence of potential treatment-related side effects.
难治性抑郁症（TRD）在成年人中很常见，且可能危及生命，辅助使用阿立哌唑治疗这些患者的益处和风险仍存在争议。因此，我们进行了一项随机对照试验（RCT）的荟萃分析，以评估辅助使用阿立哌唑治疗TRD患者的疗效、可接受性、安全性和生活质量。
系统回顾了发表在PubMed、科学网和Embase上的RCT，以评估接受辅助阿立哌唑治疗的TRD患者的疗效和安全性。主要结局指标包括缓解率、有效率、蒙哥马利-艾斯伯格抑郁量表（MADRS）、临床总体印象-严重程度（CGI-S）、临床总体印象-改善（CGI-I）、17项汉密尔顿抑郁量表（HAM-D17）、希恩残疾量表（SDS）和抑郁症状自评量表（IDS-SR）相对于基线的变化、因不良事件停药情况以及不良事件。根据研究间的异质性，使用固定效应或随机效应模型汇总风险比（RR）或加权均数差及95%置信区间（CI）。
本荟萃分析共纳入8项RCT，涉及2260例患者。与其他治疗方法相比，辅助使用阿立哌唑的缓解率（RR = 1.64，95%CI：1.42至1.89；P < 0.001）和有效率（RR = 1.45，95%CI：1.13至1.87；P = 0.004）显著更高。此外，辅助使用阿立哌唑使MADRS评分、CGI-S评分、CGI-I评分、HAM-D17评分、SDS评分和IDS-SR评分有更大变化。接受辅助阿立哌唑治疗的患者因不良事件停药的更多。辅助阿立哌唑组不良事件的发生率显著高于其他治疗组。
辅助使用阿立哌唑在提高TRD患者的有效率、缓解率和生活质量方面显示出益处。然而，鉴于存在潜在治疗相关副作用的证据，临床医生应谨慎解读这些发现。
