Pahwa, MD, Nuñez, MD, Seshadri, MD, Frye, MD, Singh, MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Gerberi, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Psychopharmacol Bull. 2020 Sep 14;50(4):118-136.
Patients with Borderline Personality Disorder (BPD) have a high prevalence of mood disorders. Lamotrigine (LAM) is often used as an off-label therapeutic option for BPD. We aimed to conduct a systematic review and meta-analysis to assess the efficacy and tolerability of LAM for the treatment of BPD.
We comprehensively searched electronic databases for eligible studies from the inception of databases to September 2019. Outcomes investigated were BPD dimensions, tolerability, and adverse events. Quality assessments were completed for the included studies. Data were summarized using random-effects model.
Of the 619 records, five studies, including three randomized controlled trials (RCT; N = 330) were included for the qualitative analysis. A meta-analysis conducted on two RCTs measuring LAM efficacy at 12 weeks, showed no statistically significant difference at 12 weeks (SMD: -0.04; 95% CI: -0.49, 0.41; p = 0.87; I = 38%) and at study endpoints (SMD: 0.18, 95%CI: -0.89, 1.26; p = 0.74; I = 86%) as compared to placebo. Sensitivity analysis on three RCTs measuring impulsivity/aggression showed no statistically significant difference between LAM and placebo (SMD: -1.84, 95% CI: -3.94, 0.23; p = 0.08; I = 95%). LAM was well tolerated, and quality assessment of the included trials was good.
Our results suggest there is limited data regarding efficacy of lamotrigine in BPD. There was no consistent evidence of lamotrigine's efficacy for the core symptom domains of BPD. Future studies should focus on examining targeted domains of BPD to clarify sub-phenotypes and individualized treatment for patients with BPD.
边缘型人格障碍（BPD）患者的心境障碍患病率较高。拉莫三嗪（LAM）常被作为 BPD 的一种非适应证治疗选择。我们旨在进行系统评价和荟萃分析，以评估 LAM 治疗 BPD 的疗效和耐受性。
我们全面检索了从数据库建立到 2019 年 9 月期间的电子数据库中符合条件的研究。调查的结果是 BPD 维度、耐受性和不良反应。对纳入的研究进行了质量评估。使用随机效应模型对数据进行总结。
在 619 条记录中，有五项研究，包括三项随机对照试验（RCT；N = 330）纳入定性分析。对两项 RCT 进行的 LAM 疗效在 12 周的 meta 分析显示，在 12 周时无统计学显著差异（SMD：-0.04；95%CI：-0.49，0.41；p = 0.87；I = 38%）和在研究终点时（SMD：0.18，95%CI：-0.89，1.26；p = 0.74；I = 86%）与安慰剂相比。对三项 RCT 进行的冲动/攻击测量的敏感性分析显示，LAM 与安慰剂之间无统计学显著差异（SMD：-1.84，95%CI：-3.94，0.23；p = 0.08；I = 95%）。LAM 耐受性良好，纳入试验的质量评估良好。
我们的结果表明，关于拉莫三嗪在 BPD 中的疗效的数据有限。没有一致的证据表明拉莫三嗪对 BPD 的核心症状域有效。未来的研究应集中在检查 BPD 的靶向域，以澄清 BPD 的亚表型和个体化治疗。
