抗精神病药物治疗精神分裂症的疗效和安全性：日本随机试验的系统评价和网络荟萃分析。
Efficacy and safety of antipsychotic treatments for schizophrenia: A systematic review and network meta-analysis of randomized trials in Japan.
机构信息
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.
Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University, MS, 38677, USA.
出版信息
J Psychiatr Res. 2021 Jun;138:444-452. doi: 10.1016/j.jpsychires.2021.04.032. Epub 2021 Apr 30.
BACKGROUND
We examined the efficacy and safety of using antipsychotic medication for schizophrenia using only randomized trials of antipsychotic for schizophrenia conducted in Japan to avoid the biological and environmental heterogeneities caused by pooling data from various races and ethnicities.
METHODS
We searched for eligible studies on Embase, PubMed, and CENTRAL. Primary outcomes were improvement in Positive and Negative Syndrome Scale total score (PANSS-T) and all-cause discontinuation. Other outcomes were improvement in PANSS subscale scores, discontinuation due to adverse events or inefficacy, and the incidence of 16 adverse events.
RESULTS
We calculated mean difference or risk ratios and 95% credible intervals. We identified 34 RCTs (6798 patients; mean study duration, 9.0 ± 4.24 weeks; proportion of male patients, 53.7%; mean age, 43.3 years). Besides placebo, studies included aripiprazole, asenapine, blonanserin, blonanserin-patch, brexpiprazole, clocapramine (no PANSS data), clozapine (no PANSS data), haloperidol, lurasidone, mosapramine, olanzapine, paliperidone, perospirone, quetiapine, and risperidone. Efficacy and safety profiles differed for antipsychotics used with schizophrenia in Japanese patients. All active treatments other than haloperidol and quetiapine outperformed placebo to improve PANSS-T. Asenapine, olanzapine, paliperidone, and risperidone outperformed placebo for all-cause discontinuation. Asenapine, blonanserin, blonanserin-patch, haloperidol, lurasidone, mosapramine, olanzapine, paliperidone, and risperidone outperformed placebo to improve PANSS positive subscale scores. Aripiprazole, asenapine, blonanserin, blonanserin-patch, brexpiprazole, lurasidone, olanzapine, paliperidone, perospirone, and risperidone outperformed placebo to improve PANSS negative subscale scores. The confidence in evidence of most outcomes was low or very low.
CONCLUSION
Our results are similar to those of previous network meta-analysis involving various races and ethnicities.
背景
我们仅使用在日本进行的抗精神病药物治疗精神分裂症的随机试验来评估抗精神病药物治疗精神分裂症的疗效和安全性，以避免因汇集来自不同种族和民族的数据而导致的生物学和环境异质性。
方法
我们在 Embase、PubMed 和 CENTRAL 上搜索了合格的研究。主要结局是阳性和阴性综合征量表总分（PANSS-T）的改善和全因停药。其他结局是 PANSS 子量表评分的改善、因不良事件或无效而停药以及 16 种不良事件的发生率。
结果
我们计算了均数差或风险比和 95%可信区间。我们确定了 34 项 RCT（6798 名患者；平均研究持续时间 9.0±4.24 周；男性患者比例 53.7%；平均年龄 43.3 岁）。除了安慰剂外，研究还包括阿立哌唑、阿塞纳平、布南色林、布南色林贴片、布瑞哌唑、氯氮平（无 PANSS 数据）、氯氮平（无 PANSS 数据）、氟哌啶醇、鲁拉西酮、莫沙必利、奥氮平、帕利哌酮、哌罗匹隆、喹硫平利培酮。在日本患者中，用于治疗精神分裂症的抗精神病药物的疗效和安全性特征不同。除氟哌啶醇和喹硫平外，所有活性治疗药物均优于安慰剂，可改善 PANSS-T。阿塞纳平、奥氮平、帕利哌酮和利培酮的全因停药率优于安慰剂。阿塞纳平、布南色林、布南色林贴片、氟哌啶醇、鲁拉西酮、莫沙必利、奥氮平、帕利哌酮和利培酮优于安慰剂，可改善 PANSS 阳性量表评分。阿立哌唑、阿塞纳平、布南色林、布南色林贴片、布瑞哌唑、鲁拉西酮、奥氮平、帕利哌酮、哌罗匹隆和利培酮优于安慰剂，可改善 PANSS 阴性量表评分。大多数结局的证据可信度较低或极低。
结论
我们的结果与涉及不同种族和民族的先前网络荟萃分析相似。
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