Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Department of Psychiatry, Komagino Hospital, Tokyo, Japan.
J Clin Psychiatry. 2021 Feb 23;82(2):20r13503. doi: 10.4088/JCP.20r13503.
To compare efficacy and safety of single daily dosing (Single-DD) vs multiple daily dosing (Multiple-DD) regimens of psychotropic drugs, the authors conducted a systematic review and meta-analysis.
A systematic literature search of MEDLINE and Embase was conducted with keywords related to dosing regimens and psychotropic drugs (last search: December 30, 2019).
Randomized controlled trials comparing clinical outcomes between Single-DD and Multiple-DD of the same formulation of the same psychotropic drugs in patients with psychiatric disorders were included.
Data on study discontinuation, psychopathology, and treatment-emergent adverse events (TEAEs) were extracted.
A total of 32 studies with 34 paired comparisons involving 3,142 patients met the eligibility criteria and were included in the meta-analysis. Various types of psychotropic drugs were examined: antidepressants (22 comparisons), antipsychotics (7 comparisons), benzodiazepines (2 comparisons), mood stabilizers (2 comparisons), and antidepressant-benzodiazepine combination (1 comparison). There was no significant difference in study discontinuation due to all causes (30 comparisons, N = 2,883, risk ratio [RR] = 1.01, 95% CI = 0.94 to 1.09, P = .77), lack of efficacy (22 comparisons, N = 2,307, RR = 1.06, 95% CI = 0.84 to 1.33, P = .62), or adverse events (25 comparisons, N = 2,571, RR = 0.93, 95% CI = 0.75 to 1.14, P = .47) between the Single-DD and Multiple-DD groups. No significant difference was found in changes in psychopathology (8 comparisons, N = 1,337, standardized mean difference = 0.00, 95% CI = -0.11 to 0.11, P = .99) between the 2 groups. These results were also true for any type of psychotropic drugs. In terms of TEAEs, however, there were significant differences in anxiety (4 comparisons, N = 347, RR = 0.53, 95% CI = 0.33 to 0.84, P = .007) and sleepiness (3 comparisons, N = 934, RR = 0.82, 95% CI = 0.68 to 0.99, P = .04) in favor of the Single-DD group.
The findings suggest Single-DD can be clinically adopted regardless of type of psychotropic drugs in patients with psychiatric disorders in general.
为了比较精神药物单剂量给药（Single-DD）与多剂量给药（Multiple-DD）方案的疗效和安全性，作者进行了系统评价和荟萃分析。
使用与给药方案和精神药物相关的关键词对 MEDLINE 和 Embase 进行了系统文献检索（最后一次检索：2019 年 12 月 30 日）。
纳入了比较同一精神药物同一制剂的单剂量和多剂量方案在精神障碍患者中的临床结局的随机对照试验。
提取了研究停药、精神病理学和治疗中出现的不良事件（TEAEs）的数据。
共有 32 项研究（34 对比较），涉及 3142 名患者符合纳入标准，并纳入荟萃分析。检查了各种类型的精神药物：抗抑郁药（22 项比较）、抗精神病药（7 项比较）、苯二氮䓬类（2 项比较）、心境稳定剂（2 项比较）和抗抑郁药-苯二氮䓬类组合（1 项比较）。由于各种原因（30 项比较，N=2883，风险比[RR] = 1.01，95%置信区间[CI] = 0.94 至 1.09，P=0.77）、缺乏疗效（22 项比较，N=2307，RR = 1.06，95%CI = 0.84 至 1.33，P=0.62）或不良事件（25 项比较，N=2571，RR = 0.93，95%CI = 0.75 至 1.14，P=0.47），单剂量和多剂量组之间无显著差异。两组之间的精神病理学变化（8 项比较，N=1337，标准化均数差=0.00，95%CI = -0.11 至 0.11，P=0.99）也无显著差异。对于任何类型的精神药物，这些结果也是如此。然而，就治疗中出现的不良事件而言，焦虑（4 项比较，N=347，RR=0.53，95%CI=0.33 至 0.84，P=0.007）和嗜睡（3 项比较，N=934，RR=0.82，95%CI=0.68 至 0.99，P=0.04）的发生率存在显著差异，有利于单剂量组。
研究结果表明，在一般精神障碍患者中，无论精神药物的类型如何，单剂量给药都可以在临床上采用。
