Psychiatry Residency Program, Faculty of Medicine and Psychology Sapienza University of Rome, Italy.
Department of Mental Health and Substance Abuse, ASL Roma 5, Rome, Italy.
J Psychopharmacol. 2021 Sep;35(9):1074-1080. doi: 10.1177/02698811211029738. Epub 2021 Jul 22.
Clozapine is the only treatment with regulatory-recognition of lowering suicidal risk, at least in schizophrenia patients. It remains uncertain whether such effects extend to other drugs for psychosis.
We searched for reports on rates of suicidal behavior during treatment with clozapine and other modern drugs for psychosis (aripiprazole, olanzapine, risperidone, quetiapine, and ziprasidone) versus comparison or control treatments and analyzed the contrasts by random-effect meta-analysis to obtain pooled odds ratios (ORs) with 95% confidence intervals (CIs).
We identified 35 paired comparisons of modern drugs for psychosis versus comparison or control treatments in 18 reports. There was moderate overall superiority of all agents tested over alternatives (OR = 0.522, = 0.004). With clozapine, this effect was large (OR = 0.229, < 0.0001) and consistent (7/7 trials), but significant antisuicidal effects were not found with other drugs for psychosis in 28 other trials (OR = 0.941, = 0.497). Apparent efficacy of specific agents ranked: risperidone ⩾ olanzapine ⩾ aripiprazole ⩾ ziprasidone ⩾ mixed drugs for psychosis ⩾ quetiapine, but none of these differences was significant.
An ability of clozapine to reduce risk of suicides and attempts in schizophrenia patients appears to be a unique effect not shared with other modern medicines indicated for schizophrenia or bipolar disorder.
氯氮平是唯一一种具有降低自杀风险监管认可的治疗药物，至少在精神分裂症患者中是如此。目前尚不清楚这些效果是否会扩展到其他精神疾病的药物。
我们搜索了氯氮平和其他用于治疗精神疾病的现代药物（阿立哌唑、奥氮平、利培酮、喹硫平和齐拉西酮）与对照或对照治疗期间自杀行为发生率的报告，并通过随机效应荟萃分析对这些对比进行分析，以获得合并优势比（OR）及其 95%置信区间（CI）。
我们在 18 份报告中确定了 35 项现代精神药物与对照或对照治疗的配对比较。所有测试药物总体上均优于替代药物（OR=0.522，=0.004）。氯氮平的效果较大（OR=0.229，<0.0001）且一致（7/7 项试验），但在其他 28 项试验中未发现其他精神药物具有明显的抗自杀作用（OR=0.941，=0.497）。特定药物的疗效排名为：利培酮≧奥氮平≧阿立哌唑≧齐拉西酮≧混合精神药物≧喹硫平，但这些差异均无统计学意义。
氯氮平降低精神分裂症患者自杀和自杀企图风险的能力似乎是一种独特的作用，与其他用于精神分裂症或双相情感障碍的现代药物不同。
