氯氮平治疗双相情感障碍：一项系统评价与荟萃分析。

Clozapine in bipolar disorder: A systematic review and meta-analysis.

作者信息

Delgado Andre, Velosa Jorge, Zhang Junyu, Dursun Serdar M, Kapczinski Flavio, de Azevedo Cardoso Taiane

机构信息

McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada; Hospital Beatriz Angelo, Department of Psychiatry and Mental Health, Loures, Portugal.

McMaster University, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Canada; Laboratory of Fear and Anxiety Disorders, Institute of Life Science, Nanchang University, Nanchang, China.

出版信息

J Psychiatr Res. 2020 Jun;125:21-27. doi: 10.1016/j.jpsychires.2020.02.026. Epub 2020 Feb 27.

DOI:10.1016/j.jpsychires.2020.02.026

PMID:32182485

Abstract

OBJECTIVES

To assess the clinical efficacy of clozapine in bipolar disorder and its adverse effect profile.

METHODS

A literature search with no year and no language restriction was conducted. The search yielded 3858 articles, with 2453 remaining after duplicate removal; 9 were suitable for the systematic review. From the 9 included studies, 3 (100 patients treated with clozapine and 102 patients treated with other antipsychotics) could be included in a meta-analysis to test clozapine efficacy in the treatment of manic episodes.

RESULTS

Clozapine's efficacy was similar to other antipsychotics (Mean difference (MD): 0.03 [95%CI: 0.86-0.92], p = 0.59) in manic episodes. The systematic review also suggested that clozapine is faster at improving symptoms in manic episodes. In addition, two studies included patients with treatment resistant bipolar disorder (TRBD) and showed that clozapine is superior to other treatments for this specific population. Sedation was the most frequent side effect (49.6%), followed by constipation (31.8%) and tachycardia (23.2%).

CONCLUSION

Clozapine's efficacy was similar to other antipsychotics in manic episodes and is superior to other antipsychotics among TRBD patients.

摘要

目的

评估氯氮平治疗双相情感障碍的临床疗效及其不良反应情况。

方法

进行无年份和语言限制的文献检索。检索得到3858篇文章，去除重复后剩余2453篇；9篇适合进行系统评价。在纳入的9项研究中，3项（100例接受氯氮平治疗的患者和102例接受其他抗精神病药物治疗的患者）可纳入荟萃分析以检验氯氮平治疗躁狂发作的疗效。

结果

在躁狂发作中，氯氮平的疗效与其他抗精神病药物相似（平均差（MD）：0.03 [95%置信区间：0.86 - 0.92]，p = 0.59）。系统评价还表明氯氮平在改善躁狂发作症状方面更快。此外，两项研究纳入了难治性双相情感障碍（TRBD）患者，结果显示氯氮平对这一特定人群优于其他治疗方法。镇静是最常见的副作用（49.6%），其次是便秘（31.8%）和心动过速（23.2%）。