Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
J Affect Disord. 2022 Mar 15;301:99-106. doi: 10.1016/j.jad.2022.01.004. Epub 2022 Jan 7.
The overarching aim of this review is to synthesize the efficacy, tolerability, and weight-mitigation effects of the olanzapine/samidorphan (OLZ/SAM) combination treatment in adults with schizophrenia and bipolar disorder-I.
A systematic search of PubMed, Web of Science, Embase, and The Cochrane Library was conducted on August 15th, 2021. Studies were included if they investigated the use of OLZ/SAM treatment in patients with schizophrenia or bipolar disorder-I, and reported the clinical outcomes: efficacy, change in weight or waist circumference, tolerability, pharmacokinetics, or change in metabolic parameters. A narrative synthesis was undertaken of the data.
Eight studies met the inclusion criteria. All identified studies were conducted in adults with schizophrenia. Compared to OLZ-monotherapy, OLZ/SAM was associated with decreased odds of developing clinically significant (>10%) weight gain (OR=0.50, 95% CI:0.31,0.80; p= 0.003) and increase in waist circumference (risk difference = -17.1% 95% CI:-26.3,-7.8) from baseline measurements respectively. In another study, OLZ was 2.7 times more associated with clinically significant weight gain as compared to OLZ/SAM (OR=2.73, 95% CI:1.11, 6.67; p = 0.023). The clinical efficacy of OLZ/SAM remained similar to OLZ with improved tolerability in both short- and long-term studies with no significantly altered pharmacokinetic properties of the constituent agents.
OLZ/SAM-treatment is associated with mitigated weight-gain liability when compared to OLZ-monotherapy in adults with schizophrenia. Additional studies are needed to ascertain patient acceptability, appropriate selection and sequencing of OLZ/SAM in the treatment algorithms for adults with schizophrenia (and BD-I), as well as to determine cost-effectiveness and long-term metabolic effects.
本综述的总体目标是综合奥氮平/萨米多佛（OLZ/SAM）联合治疗在精神分裂症和双相情感障碍 I 型成人中的疗效、耐受性和体重缓解作用。
我们于 2021 年 8 月 15 日对 PubMed、Web of Science、Embase 和 The Cochrane Library 进行了系统检索。如果研究调查了 OLZ/SAM 治疗在精神分裂症或双相情感障碍 I 型患者中的应用，并报告了临床结果：疗效、体重或腰围变化、耐受性、药代动力学或代谢参数变化，则将其纳入研究。对数据进行了叙述性综合。
八项研究符合纳入标准。所有确定的研究均在成人精神分裂症患者中进行。与 OLZ 单一疗法相比，OLZ/SAM 与降低发生临床显著（>10%）体重增加的几率相关（OR=0.50，95%CI：0.31，0.80；p=0.003）和从基线测量值分别增加腰围（风险差异=-17.1%95%CI：-26.3，-7.8）。在另一项研究中，OLZ 与 OLZ/SAM 相比，更易发生临床显著体重增加（OR=2.73，95%CI：1.11，6.67；p=0.023）。OLZ/SAM 的临床疗效与 OLZ 相似，在短期和长期研究中耐受性更好，且组成药物的药代动力学特性没有明显改变。
与 OLZ 单一疗法相比，OLZ/SAM 治疗与减轻体重增加的风险相关，在精神分裂症成人中。需要进一步的研究来确定患者的可接受性，适当选择和序贯 OLZ/SAM 在精神分裂症（和 BD-I）成人的治疗方案中，并确定成本效益和长期代谢影响。
