Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Acta Psychiatr Scand. 2019 May;139(5):404-419. doi: 10.1111/acps.13016. Epub 2019 Mar 28.
No study has gathered evidence from all randomized clinical trials (RCTs) with anti-inflammatory drugs measuring antidepressant effects including a detailed assessment of side-effects and bias.
We performed a systematic review identifying RCTs published prior to January 1, 2018, studying antidepressant treatment effects and side-effects of pharmacological anti-inflammatory intervention in adults with major depressive disorder (MDD) or depressive symptoms. Outcomes were depression scores after treatment, remission, response, and side-effects. Pooled standard mean differences (SMD) and risk ratios (RR) including 95% confidence intervals (95%-CI) were calculated.
We identified 36 RCTs, whereof 13 investigated NSAIDs (N = 4214), 9 cytokine inhibitors (N = 3345), seven statins (N = 1576), 3 minocycline (N = 151), 2 pioglitazone (N = 77), and 2 glucocorticoids (N = 59). Anti-inflammatory agents improved depressive symptoms compared to placebo as add-on in patients with MDD (SMD = -0.64; 95%-CI = -0.88, -0.40; I = 51%; N = 597) and as monotherapy (SMD = -0.41; 95%-CI = -0.60, -0.22; I = 93%, N = 8825). Anti-inflammatory add-on improved response (RR = 1.76; 95%-CI = 1.44-2.16; I = 16%; N = 341) and remission (RR = 2.14; 95%-CI = 1.03-4.48; I = 57%; N = 270). We found a trend toward an increased risk for infections, and all studies showed high risk of bias.
Anti-inflammatory agents improved antidepressant treatment effects. Future RCTs need to include longer follow-up, identify optimal doses and subgroups of patients that can benefit from anti-inflammatory intervention.
尚无研究从所有评估抗炎药物抗抑郁效果的随机临床试验（RCT）中收集证据，包括对副作用和偏倚的详细评估。
我们进行了一项系统评价，以确定在 2018 年 1 月 1 日之前发表的 RCT，研究了在患有重度抑郁症（MDD）或抑郁症状的成年人中，药理学抗炎干预的抗抑郁治疗效果和副作用。结局是治疗后抑郁评分、缓解、反应和副作用。计算了汇总后的标准均数差（SMD）和风险比（RR），包括 95%置信区间（95%-CI）。
我们确定了 36 项 RCT，其中 13 项研究了 NSAIDs（N=4214），9 项研究了细胞因子抑制剂（N=3345），7 项研究了他汀类药物（N=1576），3 项研究了米诺环素（N=151），2 项研究了吡格列酮（N=77），2 项研究了糖皮质激素（N=59）。抗炎药物作为 MDD 患者的附加治疗（SMD=-0.64；95%-CI=-0.88，-0.40；I=51%；N=597）和单药治疗（SMD=-0.41；95%-CI=-0.60，-0.22；I=93%；N=8825）均能改善抑郁症状。抗炎药物的附加治疗能改善反应（RR=1.76；95%-CI=1.44-2.16；I=16%；N=341）和缓解（RR=2.14；95%-CI=1.03-4.48；I=57%；N=270）。我们发现感染风险增加的趋势，而且所有研究均显示出高偏倚风险。
抗炎药物改善了抗抑郁治疗效果。未来的 RCT 需要包括更长的随访时间，确定最佳剂量和可能受益于抗炎干预的患者亚组。
