Bradbury Michelle, Hutton Brian, Beltran-Bless Ana-Alicia, Alzahrani Mashari, Lariviere Thomas, Fernandes Ricardo, Ibrahim Mohammed Fk, Cole Katherine, Hilton John, Vandermeer Lisa, Shorr Risa, Larocque Gail, Clemons Mark
Department of Medicine, The Ottawa Hospital, Ottawa, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Clin Breast Cancer. 2022 Apr;22(3):e362-e373. doi: 10.1016/j.clbc.2021.10.003. Epub 2021 Oct 9.
Concerns around pharmacological interaction between tamoxifen and antidepressants have resulted in evidence-base guidelines that recommend avoidance or caution with concurrent use. It remains unclear however whether this interaction is clinically important. A systematic review of studies comparing endocrine therapy (including tamoxifen and aromatase inhibitors) alone or concurrent with antidepressants in breast cancer patients was performed. The literature search sought studies within MEDLINE, EMBASE, and the Cochrane Collaboration Library published from database inception until December 1, 2020. Outcomes of interest included recurrence, breast cancer-specific survival, overall mortality, quality of life, and treatment compliance. Studies were assessed with the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle Ottawa tool for case-control and cohort studies. From 695 citations, we included 15 studies (2 randomized controlled trials [255 patients], 10 retrospective cohort studies [75,678 patients], and 3 case-control studies [18,836 patients]). While between-study clinical and methodologic differences (including analysis of confounding variables) precluded formal meta-analysis, findings from included studies did not find consistent evidence that concurrent use of antidepressants (including paroxetine) with tamoxifen therapy has negative impacts on the outcomes of interest. In this systematic review, despite data from nearly 100,000 patients, concurrent use of tamoxifen and antidepressants showed no consistent negative effect on clinical outcomes. Given the recognized harm to patients of changing either endocrine therapy or antidepressants to avoid concurrent use, current evidence-based guidelines should be updated accordingly. More rigorously designed pharmacoepidemiologic studies are needed.
对他莫昔芬与抗抑郁药之间药物相互作用的担忧已产生了循证指南，建议避免或谨慎同时使用。然而，这种相互作用在临床上是否重要仍不清楚。我们对比较单独使用内分泌治疗（包括他莫昔芬和芳香化酶抑制剂）或与抗抑郁药同时使用对乳腺癌患者影响的研究进行了系统评价。文献检索在MEDLINE、EMBASE和Cochrane协作图书馆中进行，检索从数据库建立至2020年12月1日发表的研究。感兴趣的结局包括复发、乳腺癌特异性生存、总死亡率、生活质量和治疗依从性。采用Cochrane偏倚风险工具对随机对照试验进行评估，采用纽卡斯尔渥太华工具对病例对照研究和队列研究进行评估。从695篇文献中，我们纳入了15项研究（2项随机对照试验[255例患者]、10项回顾性队列研究[75,678例患者]和3项病例对照研究[18,836例患者]）。虽然研究间的临床和方法学差异（包括对混杂变量的分析）妨碍了正式的荟萃分析，但纳入研究的结果并未发现一致的证据表明抗抑郁药（包括帕罗西汀）与他莫昔芬治疗同时使用会对感兴趣的结局产生负面影响。在这项系统评价中，尽管有近100,000例患者的数据，但他莫昔芬与抗抑郁药同时使用对临床结局并未显示出一致的负面影响。鉴于认识到改变内分泌治疗或抗抑郁药以避免同时使用对患者有危害，当前的循证指南应相应更新。需要更严格设计的药物流行病学研究。
