Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Schizophr Res. 2021 Mar;229:3-11. doi: 10.1016/j.schres.2021.01.021. Epub 2021 Feb 17.
Psychomotor agitation is a common condition in patients with psychotic disorders. One treatment possibility is intramuscular (IM) second-generation antipsychotics. Yet their efficacy in this formulation and for this aim is unclear. This network meta-analysis aims to evaluate the efficacy of short-acting IM second-generation antipsychotic drugs, haloperidol and placebo in patients with diagnosis of schizophrenia and schizophrenia-like disorders that present acute agitation.
We searched the Cochrane Schizophrenia Group Controlled Trials Register, MEDLINE, EMBASE, PsycINFO, Cochrane Library, PubMed, BIOSIS, ClinicalTrials.gov and WHO ICTRP up to November 2018 and PubMed until March 2020. Study selection and outcome extraction were performed independently by two reviewers. Pairwise and network meta-analyses were conducted to compare the different IM second-generation antipsychotics among themselves and with IM haloperidol and placebo. The primary outcome was the number of responders at 2 h after the first injection. Responders at 24 h were also analysed.
10 studies with 1964 patients were included in the meta-analysis. Ziprasidone, olanzapine, aripiprazole and haloperidol were more efficacious than placebo in calming patients at 2 h after administration. Furthermore, olanzapine was superior to aripiprazole. The results at 24 h confirmed the superiority of aripiprazole, olanzapine and haloperidol over placebo, while for ziprasidone no data were available.
All second-generation antipsychotics available as intramuscular medications were effective in reducing agitation in people with schizophrenia. Olanzapine was somewhat more efficacious than aripiprazole.
精神运动性激越是精神障碍患者的常见症状。一种治疗选择是肌肉注射（IM）第二代抗精神病药。然而，其在这种配方中的疗效和目的尚不清楚。这项网络荟萃分析旨在评估短效 IM 第二代抗精神病药物，氟哌啶醇和安慰剂在诊断为精神分裂症和精神分裂样障碍且出现急性激越的患者中的疗效。
我们检索了 Cochrane 精神分裂症组对照试验登记处、MEDLINE、EMBASE、PsycINFO、Cochrane 图书馆、PubMed、BIOSIS、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台，截至 2018 年 11 月和 PubMed 截至 2020 年 3 月。由两名评审员独立进行研究选择和结果提取。进行了两两和网络荟萃分析，以比较不同的 IM 第二代抗精神病药之间以及与 IM 氟哌啶醇和安慰剂的疗效。主要结局是首次注射后 2 小时的应答者数量。还分析了 24 小时的应答者。
纳入了 10 项研究共 1964 名患者的荟萃分析。在给药后 2 小时，齐拉西酮、奥氮平、阿立哌唑和氟哌啶醇比安慰剂更能有效地使患者镇静。此外，奥氮平优于阿立哌唑。24 小时的结果证实了阿立哌唑、奥氮平和氟哌啶醇优于安慰剂，而齐拉西酮则没有数据。
所有可作为肌肉注射的第二代抗精神病药物在减少精神分裂症患者的激越方面都有效。奥氮平的疗效略优于阿立哌唑。
