Luft Marissa J, Dobson Eric T, Levine Amir, Croarkin Paul E, Strawn Jeffrey R
Anxiety Disorders Research Program, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
CNS Spectr. 2021 Apr 12:1-10. doi: 10.1017/S1092852921000377.
Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking.
To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: -1.8, 95% credible interval [CrI]: [-3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: -1.2, 95% CrI [-2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.
While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.
尽管抗抑郁药相关的性功能副作用很常见，但针对这些问题副作用的治疗方法比较仍很缺乏。
为解决这一问题，我们进行了一项系统评价和贝叶斯网络荟萃分析，以比较针对成人抗抑郁药所致性功能障碍的干预措施。通过PubMed和clinicaltrials.gov，我们识别了1985年至2020年9月期间已发表和未发表的前瞻性治疗试验（主要结局：亚利桑那性体验量表[ASEX]评分）。使用推荐分级的评估、制定和评价框架评估证据质量。
我们识别了57篇引文（27项随机对照试验、66个治疗组、27项开放标签试验和3项交叉试验），这些研究评估了33种干预措施（3108例患者）。在系统评价中，44%（25/57）的试验报告了成功的干预措施；与安慰剂对照研究（22%，6/27）相比，这在开放标签试验中更常见（70%，19/27）。在使用ASEX的安慰剂对照研究的荟萃分析中（N = 8），碧萝芷优于安慰剂（标准化均差：-1.8，95%可信区间[CrI]：[-3.7至0.0]），并且有证据表明，在6%的阈值下，西地那非可改善性功能障碍（标准化均差：-1.2，95% CrI [-2.5至0.1]）。在包括单臂研究的荟萃分析中（15项研究），与安慰剂相比，西地那非、噻奈普汀、玛卡、加巴喷丁和米氮平的治疗反应更常见，但这些差异未达到统计学意义。
虽然随机对照试验之间的异质性使得确定单一最佳干预措施变得复杂，但多项试验表明西地那非可改善抗抑郁药所致性功能障碍。需要更多的随机对照试验来检验其他干预措施的假定疗效。
