ECT 增强氯氮平治疗氯氮平抵抗性精神分裂症：一项随机对照试验的荟萃分析。
ECT augmentation of clozapine for clozapine-resistant schizophrenia: A meta-analysis of randomized controlled trials.
机构信息
National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China.
出版信息
J Psychiatr Res. 2018 Oct;105:23-32. doi: 10.1016/j.jpsychires.2018.08.002. Epub 2018 Aug 2.
UNLABELLED
Treatment-resistant schizophrenia (TRS) is common and debilitating. A subgroup of patients even has clozapine-resistant schizophrenia (CRS). We aimed to evaluate the efficacy and safety of electroconvulsive therapy (ECT) augmentation of clozapine for CRS. Systematic literature search of randomized controlled trials (RCTs) reporting on ECT augmentation of clozapine in CRS. Co-primary outcomes included symptomatic improvement at post-ECT assessment and study endpoint. Eighteen RCTs (n = 1769) with 20 active treatment arms were identified and meta-analyzed. Adjunctive ECT was superior to clozapine regarding symptomatic improvement at post-ECT assessment (Standardized Mean Difference (SMD) = -0.88, 95% Confidence Interval (CI): -1.33 to -0.44; I = 86%, P = 0.0001) and endpoint assessment (SMD: -1.44, 95%CI: -2.05 to -0.84; I = 95%, P < 0.00001), separating as early as week 1-2 (SMD = -0.54, 95%CI: -0.88 to -0.20; I = 77%, P = 0.002). Adjunctive ECT was also superior regarding study-defined response at post-ECT assessment (53.6% vs. 25.4%, Risk Ratio (RR) = 1.94, 95%CI: 1.59-2.36; I = 0%, P < 0.00001, number-needed-to-treat (NNT) = 3, 95%CI: 3-5) and endpoint assessment (67.7% vs. 41.4%, RR = 1.66, 95%CI: 1.38-1.99; I = 47%, P < 0.00001, NNT = 4, 95%CI: 3-8), and remission at post-ECT assessment (13.3% vs. 3.7%, RR = 3.28, 95%CI: 1.80-5.99; I = 0%, P = 0.0001, NNT = 13, 95%CI: 6-100) and endpoint assessment (23.6% vs. 13.3%, RR = 1.80, 95%CI: 1.39 to 2.35; I = 5%, P < 0.0001, NNT = 14, 95%CI: 6-50). Patient-reported memory impairment (24.2% vs. 0%; RR = 16.10 (95%CI: 4.53-57.26); I = 0%, P < 0.0001, number-needed-to-harm (NNH) = 4, 95%CI: 2-14) and headache (14.5% vs 1.6%; RR = 4.03 (95%CI: 1.54-10.56); I = 0%, P = 0.005, NNH = 8, 95%CI: 4-50) occurred more frequently with adjunctive ECT. No significant group differences were found regarding discontinuation and other adverse effects. Despite increased frequency of self-reported memory impairment and headache, ECT augmentation of clozapine is a highly effective and relatively safe treatment for CRS.
REGISTRATION NUMBER
CRD42018089959.
背景
治疗抵抗性精神分裂症（TRS）较为常见且具致残性。甚至有一小部分患者对氯氮平也有抵抗。我们旨在评估电休克治疗（ECT）对氯氮平治疗氯氮平抵抗性精神分裂症（CRS）的增效作用。
方法
系统检索氯氮平增效ECT 治疗 CRS 的随机对照试验（RCT）的文献。主要结局包括 ECT 后和研究终点时的症状改善。
结果
确定了 18 项 RCT（n=1769）和 20 个对照治疗组，并进行了荟萃分析。与氯氮平相比，附加 ECT 在 ECT 后评估（标准均数差[SMD] =-0.88，95%置信区间[CI]：-1.33 至-0.44；I=86%，P=0.0001）和终点评估（SMD：-1.44，95%CI：-2.05 至-0.84；I=95%，P<0.00001）方面均有优势，在第 1-2 周（SMD=-0.54，95%CI：-0.88 至-0.20；I=77%，P=0.002）差异更早出现。附加 ECT 在 ECT 后评估时也具有研究定义的反应优势（53.6% vs. 25.4%，风险比[RR] =1.94，95%CI：1.59-2.36；I=0%，P<0.00001，需要治疗的人数[NNT] =3，95%CI：3-5）和终点评估（67.7% vs. 41.4%，RR=1.66，95%CI：1.38-1.99；I=47%，P<0.00001，NNT=4，95%CI：3-8），以及 ECT 后评估时的缓解率（13.3% vs. 3.7%，RR=3.28，95%CI：1.80-5.99；I=0%，P=0.0001，NNT=13，95%CI：6-100）和终点评估（23.6% vs. 13.3%，RR=1.80，95%CI：1.39-2.35；I=5%，P<0.0001，NNT=14，95%CI：6-50）。与氯氮平相比，附加 ECT 时患者报告的记忆障碍（24.2% vs. 0%；RR=16.10（95%CI：4.53-57.26）；I=0%，P<0.0001，需要治疗的人数[NNT] =4，95%CI：2-14）和头痛（14.5% vs. 1.6%；RR=4.03（95%CI：1.54-10.56）；I=0%，P=0.005，NNT=8，95%CI：4-50）更为常见。关于停药和其他不良反应，未发现两组间有显著差异。尽管自我报告的记忆障碍和头痛的频率增加，但氯氮平增效 ECT 仍是 CRS 的一种非常有效且相对安全的治疗方法。
登记号
CRD42018089959。
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