Zhang Ling, Qi Han, Xie Yun-Yi, Zheng Wei, Liu Xiao-Hui, Cai Dong-Bin, Ng Chee H, Ungvari Gabor S, Xiang Yu-Tao
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Front Psychiatry. 2021 Sep 29;12:728204. doi: 10.3389/fpsyt.2021.728204. eCollection 2021.
Aripiprazole, metformin, and paeoniae-glycyrrhiza decoction (PGD) have been widely used as adjunctive treatments to reduce antipsychotic (AP)-induced hyperprolactinemia in patients with schizophrenia. However, the comparative efficacy and safety of these medications have not been previously studied. A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety between aripiprazole, metformin, and PGD as adjunctive medications in reducing AP-induced hyperprolactinemia in schizophrenia. Both international (PubMed, PsycINFO, EMBASE, and Cochrane Library databases) and Chinese (WanFang, Chinese Biomedical, and Chinese National Knowledge infrastructure) databases were searched from their inception until January 3, 2019. Data were analyzed using the Bayesian Markov Chain Monte Carlo simulations with the WinBUGS software. A total of 62 RCTs with 5,550 participants were included in the meta-analysis. Of the nine groups of treatments included, adjunctive aripiprazole (<5 mg/day) was associated with the most significant reduction in prolactin levels compared to placebo (posterior MD = -65.52, 95% CI = -104.91, -24.08) and the other eight treatment groups. Moreover, adjunctive PGD (>1:1) was associated with the lowest rate of all-cause discontinuation compared to placebo (posterior odds ratio = 0.45, 95% CI = 0.10, 3.13) and adjunctive aripiprazole (>10 mg/day) was associated with fewer total adverse drug events than placebo (posterior OR = 0.93, 95% CI = 0.65, 1.77) and other eight treatment groups. In addition, when risperidone, amisulpride, and olanzapine were the primary AP medications, adjunctive paeoniae/glycyrrhiza = 1:1, aripiprazole <5 mg/day, and aripiprazole >10 mg/day were the most effective treatments in reducing the prolactin levels, respectively. Adjunctive aripiprazole, metformin, and PGD showed beneficial effects in reducing AP-induced hyperprolactinemia in schizophrenia, with aripiprazole (<5 mg/day) being the most effective one.
阿立哌唑、二甲双胍和芍药甘草汤（PGD）已被广泛用作辅助治疗药物，以降低精神分裂症患者抗精神病药物（AP）所致的高催乳素血症。然而，这些药物的疗效和安全性比较此前尚未得到研究。本研究进行了一项随机对照试验（RCT）的网状Meta分析，以比较阿立哌唑、二甲双胍和PGD作为辅助药物在降低精神分裂症患者AP所致高催乳素血症方面的疗效和安全性。检索了国际数据库（PubMed、PsycINFO、EMBASE和Cochrane图书馆数据库）以及中国数据库（万方、中国生物医学数据库和中国知网），检索时间从建库至2019年1月3日。使用WinBUGS软件通过贝叶斯马尔可夫链蒙特卡罗模拟对数据进行分析。本Meta分析共纳入62项RCT，涉及5550名参与者。在纳入的九组治疗中，与安慰剂（后验MD=-65.52，95%CI=-104.91，-24.08）及其他八组治疗相比，辅助使用阿立哌唑（<5mg/天）使催乳素水平降低最为显著。此外，与安慰剂相比，辅助使用PGD（>1:1）导致的全因停药率最低（后验比值比=0.45，95%CI=0.10，3.13），辅助使用阿立哌唑（>10mg/天）导致的药物不良事件总数比安慰剂及其他八组治疗更少（后验OR=0.93，95%CI=0.65，1.77）。此外，当利培酮、氨磺必利和奥氮平作为主要AP药物时，辅助使用芍药/甘草=1:1、阿立哌唑<5mg/天和阿立哌唑>10mg/天分别是降低催乳素水平最有效的治疗方法。辅助使用阿立哌唑、二甲双胍和PGD在降低精神分裂症患者AP所致高催乳素血症方面显示出有益效果，其中阿立哌唑（<5mg/天）最为有效。
