Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Radboud University Medical Center Alzheimer Center, Nijmegen, The Netherlands.
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
J Clin Epidemiol. 2018 Sep;101:17-27. doi: 10.1016/j.jclinepi.2018.05.004. Epub 2018 May 18.
Postulating that efficacy of antipsychotics for agitation and psychosis in dementia is best estimated in trials among patients with these symptoms and with symptom-specific outcomes, we investigated whether clinically broader definitions affected the pooled efficacy.
Trials were searched in multiple databases and categorized according to patient population (agitated, psychotic, and mixed) and outcome scale (agitation, psychosis, and generic). Standardized mean differences with 95% confidence intervals were calculated for conventional and atypical antipsychotics separately.
Thirty trials met our inclusion criteria. Conventional antipsychotics might have a small effect in agitated patients on agitation scales (-0.44, -0.88, 0.01) and in psychotic patients on psychosis scales (-0.31, -0.61, -0.02). There was no effect on generic scales. Efficacy of atypical antipsychotics was not established in agitated patients on agitation scales (-0.15, -0.43, 0.13) and in psychotic patients on psychosis scales (-0.11, -0.20, -0.03) but was small in mixed patients on agitation scales (-0.29, -0.40, -0.18).
Pooled efficacy of antipsychotics for agitation and psychosis in dementia is biased when based on trials that included patients without these target symptoms or on results measured with generic scales. This finding is important for reviewers and guideline developers who select trials for reviews.
假设抗精神病药治疗痴呆症激越和精神病的疗效在针对这些症状且具有症状特异性结局的患者中进行的试验中得到最佳估计，我们调查了更广泛的临床定义是否会影响汇总疗效。
在多个数据库中搜索试验，并根据患者人群（激越、精神病和混合）和结局量表（激越、精神病和一般）进行分类。分别为传统和非典型抗精神病药计算标准化均数差值及其 95%置信区间。
符合纳入标准的试验有 30 项。对于激越患者，传统抗精神病药在激越量表上可能有较小的疗效（-0.44，-0.88，0.01），在精神病患者在精神病量表上也可能有较小的疗效（-0.31，-0.61，-0.02）。在一般量表上则没有效果。对于激越患者，非典型抗精神病药在激越量表上的疗效不明确（-0.15，-0.43，0.13），在精神病患者在精神病量表上的疗效也不明确（-0.11，-0.20，-0.03），但在混合患者的激越量表上的疗效较小（-0.29，-0.40，-0.18）。
基于纳入无这些目标症状的患者或采用一般量表测量结果的试验，汇总痴呆症激越和精神病的抗精神病药疗效存在偏倚。这一发现对于为综述选择试验的评审员和指南制定者来说非常重要。
