精神分裂症急性期抗精神病药物试验中药物反应和安慰剂反应脱钩?荟萃回归分析。
Disconnection of drug-response and placebo-response in acute-phase antipsychotic drug trials on schizophrenia? Meta-regression analysis.
机构信息
Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.
INSERM, UMR1153 Epidemiology and Statistics, Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Cochrane France, Paris, France.
出版信息
Neuropsychopharmacology. 2019 Oct;44(11):1955-1966. doi: 10.1038/s41386-019-0440-6. Epub 2019 Jun 18.
Differences in efficacy between antipsychotics and placebo in schizophrenia trials have decreased over the past decades. Previous studies have tried to identify potential explanatory factors focusing on response to placebo; however, it is still not clear which factors, if any, specifically moderate drug-response, as they may be different from those moderating placebo-response. Therefore, in this meta-regression analysis we explore whether there is an interaction between drug-response and placebo-response in terms of effect size. We systematically searched multiple electronic databases, ClinicalTrials.gov, and the US Food and Drug Administration website for randomized, placebo-controlled trials investigating the efficacy of antipsychotics in patients with acute schizophrenia (last update: October 2016). The main outcome was the change on the Brief Psychiatric Rating Scale or the Positive and Negative Syndrome Scale score from baseline to endpoint after at least 3 weeks of treatment. Multiple patient-, design-, and drug-related potential predictors of response were analyzed by meta-regressions, as predefined in the study protocol. Overall, 167 trials with 28,102 participants were included. Publication year, the number of participants and sites, mean dose, minimum severity threshold as an inclusion criterion, chronicity, industry sponsorship, type of rating scale, diagnostic criteria, and number of medications had a different impact on drug and placebo response. By contrast, baseline severity, duration of wash-out, study duration, and study region affected drug and placebo response in a similar way without a net effect on effect sizes. No other factors had a significant effect on either drug-response or placebo-response. In conclusion, as individual moderators may have different impact on placebo-response and drug-response, it is important to consider also the specific factors influencing drug-response in order to fully understand the difference between antipsychotics and placebo. These results shed further light on the phenomenon of decreasing effect size of antipsychotics for schizophrenia over time and should help design future randomized controlled trials in the field (Prospero registration number CRD42013003342).
在过去的几十年中,抗精神病药物治疗精神分裂症的疗效与安慰剂之间的差异已经缩小。先前的研究试图确定潜在的解释因素,重点是对安慰剂的反应;然而,目前尚不清楚哪些因素(如果有的话)可以具体调节药物反应,因为它们可能与调节安慰剂反应的因素不同。因此,在这项荟萃回归分析中,我们探讨了药物反应和安慰剂反应在效应大小方面是否存在相互作用。我们系统地搜索了多个电子数据库、ClinicalTrials.gov 和美国食品和药物管理局网站,以寻找评估抗精神病药治疗急性精神分裂症患者疗效的随机、安慰剂对照试验(最后更新:2016 年 10 月)。主要结果是从基线到至少 3 周治疗后的终点时,简明精神病评定量表或阳性和阴性综合征量表评分的变化。通过荟萃回归分析,根据研究方案的预先设定,分析了多种患者、设计和药物相关的潜在预测因素。总体而言,纳入了 167 项试验,共 28102 名参与者。发表年份、参与者和地点的数量、平均剂量、最低严重程度阈值作为纳入标准、慢性、工业赞助、量表类型、诊断标准和药物种类对药物和安慰剂反应有不同的影响。相比之下,基线严重程度、洗脱期持续时间、研究持续时间和研究区域以类似的方式影响药物和安慰剂反应,而对效应大小没有净影响。没有其他因素对药物反应或安慰剂反应有显著影响。总之,由于个体调节剂可能对安慰剂反应和药物反应有不同的影响,因此,为了全面了解抗精神病药与安慰剂之间的差异,还需要考虑影响药物反应的具体因素。这些结果进一步阐明了抗精神病药治疗精神分裂症的疗效随时间缩小的现象,并有助于设计该领域的未来随机对照试验(PROSPERO 注册号:CRD42013003342)。