系统评价和荟萃分析在抑郁障碍中补充 L- 甲基叶酸的作用。

Systematic Review and Meta-Analysis of L-Methylfolate Augmentation in Depressive Disorders.

机构信息

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.

Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada.

出版信息

Pharmacopsychiatry. 2022 May;55(3):139-147. doi: 10.1055/a-1681-2047. Epub 2021 Nov 18.

DOI:10.1055/a-1681-2047

PMID:34794190

Abstract

OBJECTIVES

Partial response to pharmacotherapy is common in major depressive disorder (MDD) and many patients require alternative pharmacotherapy or augmentation, including adjunctive L-methylfolate. Given that L-methylfolate augmentation is rarely included in major clinical practice guidelines, we sought to systematically review evidence for L-methylfolate augmentation in adults with MDD and to examine its efficacy meta-analytically.

METHODS

We systematically searched PubMed for articles up to December 31, 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Included studies were published in peer-reviewed, English-language journals and examined L-methylfolate adjunctive therapy in depressive disorders or its effect on antidepressant response. A fixed- and random-effects meta-analysis and risk of bias assessment using the Cochrane Risk of Bias Tool were conducted.

RESULTS

Qualitative assessment of nine articles (N=6,707 patients) suggests that adjunctive L-methylfolate improved antidepressant response. In the meta-analysis of categorical Hamilton Rating Scale for Depression-17 response, (three studies, 483) adjunctive L-methylfolate was associated with a small effect versus antidepressant monotherapy (relative risk: 1.25, 95% confidence interval [CI]=1.08 to 1.46, 0.004). A meta-analysis of four studies (507) using a continuous measure of depressive symptoms showed a similar effect of adjunctive L-methylfolate (standardized mean difference=- 0.38, 95% CI=- 0.59 to-0.17, 0.0003).

CONCLUSION

Adjunctive L-methylfolate may have modest efficacy in antidepressant-treated adults with MDD.

摘要

目的

在重度抑郁症（MDD）中，药物治疗部分缓解较为常见，许多患者需要替代药物治疗或增效治疗，包括辅助使用 L- 甲基叶酸。鉴于 L- 甲基叶酸增效治疗很少被纳入主要临床实践指南，我们旨在系统地综述 L- 甲基叶酸增效治疗 MDD 成人患者的证据，并进行荟萃分析以评估其疗效。

方法

我们按照系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）建议，对截至 2020 年 12 月 31 日的 PubMed 中的文章进行了系统检索。纳入的研究发表于同行评审的英文期刊，研究了 L- 甲基叶酸在抑郁障碍中的辅助治疗或对抗抑郁反应的影响。我们进行了固定效应和随机效应荟萃分析，并使用 Cochrane 偏倚风险工具进行了偏倚风险评估。

结果

定性评估 9 篇文章（N=6707 例患者）表明，辅助使用 L- 甲基叶酸可改善抗抑郁反应。在汉密尔顿抑郁量表-17 项评分的分类应答的荟萃分析中（3 项研究，483 例患者），与抗抑郁药单药治疗相比，辅助使用 L- 甲基叶酸与较小的应答效应相关（相对风险：1.25，95%置信区间 [CI] =1.08 至 1.46，0.004）。使用抑郁症状连续测量指标的 4 项研究（507 例患者）的荟萃分析显示，辅助使用 L- 甲基叶酸也具有相似的效应（标准化均数差=-0.38，95%CI=-0.59 至-0.17，0.0003）。