Jiang De-Qi, Jiang Li-Lin, Wang Yan, Li Ming-Xing
Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, 537000, China.
Department of Pharmacy, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, 528200, China.
Asian J Psychiatr. 2021 Jul;61:102691. doi: 10.1016/j.ajp.2021.102691. Epub 2021 May 10.
The aim of this report was to evaluate the clinical efficacy and safety of pramipexole therapy for patients with depression and Parkinson's disease (dPD), in order to confer a reference for clinical practice.
Randomized controlled trials (RCTs) of pramipexole for dPD published up to June 2020 were retrieved. Standardised mean difference (SMD), risk ratio (RR), and 95 % confidence interval (CI) were calculated. The outcomes included efficacy, Hamilton depression rating scale (HAMD) score, unified Parkinson's disease rating scale (UPDRS) scores, self-rating depression scale (SDS) score, self-rating anxiety scale (SAS) score or adverse events.
Eighteen RCTs with 1789 participants were included. Clinical efficacy in pramipexole treatment group was significantly better than control group (RR 1.26, 95 % CI 1.20-1.33, P < 0.00001). Compared with control group, the pooled effects of pramipexole therapy on depression were (SMD -1.90, 95 % CI -2.58 to -1.23, P < 0.00001) for HAMD score, (SMD -3.94, 95 % CI -4.73 to -3.15, P < 0.00001) for SDS score, pramipexole therapy also decreased SAS score markedly (P < 0.0001). Compared with control group, the pooled effects of pramipexole on motor UPDRS score and activities of daily living UPDRS score were statistically significant (P < 0.01). Furthermore, pramipexole therapy didn't increase the number of any adverse events in dPD patients (RR 0.72, 95 % CI 0.37-1.41, P = 0.34).
Pramipexole therapy can alleviate depressive symptoms and motor dysfunction in dPD patients, and there were no more side effects associated with drug intervention. These findings should be further validated by high-quality and well-designed RCTs.
本报告旨在评估普拉克索治疗伴有抑郁症的帕金森病（dPD）患者的临床疗效和安全性，为临床实践提供参考。
检索截至2020年6月发表的关于普拉克索治疗dPD的随机对照试验（RCT）。计算标准化均数差（SMD）、风险比（RR）和95%置信区间（CI）。结局指标包括疗效、汉密尔顿抑郁量表（HAMD）评分、统一帕金森病评定量表（UPDRS）评分、自评抑郁量表（SDS）评分、自评焦虑量表（SAS）评分或不良事件。
纳入18项RCT，共1789名参与者。普拉克索治疗组的临床疗效显著优于对照组（RR 1.26，95%CI 1.20 - 1.33，P < 0.00001）。与对照组相比，普拉克索治疗对抑郁的合并效应为：HAMD评分为（SMD - 1.90，95%CI - 2.58至 - 1.23，P < 0.00001），SDS评分为（SMD - 3.94，95%CI - 4.73至 - 3.15，P < 0.00001），普拉克索治疗也显著降低了SAS评分（P < 0.0001）。与对照组相比，普拉克索对运动UPDRS评分和日常生活活动UPDRS评分的合并效应具有统计学意义（P < 0.01）。此外，普拉克索治疗未增加dPD患者任何不良事件数量（RR 0.72，95%CI 0.37 - 1.41，P = 0.34）。
普拉克索治疗可缓解dPD患者的抑郁症状和运动功能障碍，且药物干预无更多副作用。这些发现应通过高质量、精心设计的RCT进一步验证。
