Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF, UK.
South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK.
Neuropsychopharmacology. 2022 Mar;47(4):880-890. doi: 10.1038/s41386-021-01255-4. Epub 2022 Jan 11.
Ondansetron is a selective serotonin (5HT3) receptor antagonist that is under evaluation as an adjunctive treatment for schizophrenia, and a novel treatment for hallucinations in Parkinson's disease. Ondansetron reverses sensory gating deficits and improves visuoperceptual processing in animal models of psychosis, but it is unclear to what extent preclinical findings have been replicated in humans. We systematically reviewed human studies that evaluated the effects of ondansetron and other 5HT3 receptor antagonists on sensory gating deficits or sensory processing. Of 11 eligible studies, eight included patients with schizophrenia who were chronically stable on antipsychotic medication; five measured sensory gating using the P50 suppression response to a repeated auditory stimulus; others included tests of visuoperceptual function. Three studies in healthy participants included tests of visuoperceptual and sensorimotor function. A consistent and robust finding (five studies) was that ondansetron and tropisetron (5HT3 antagonist and α7-nicotinic receptor partial agonist) improved sensory gating in patients with schizophrenia. Tropisetron also improved sustained visual attention in non-smoking patients. There was inconsistent evidence of the effects of 5HT3 antagonists on other measures of sensory processing, but interpretation was limited by the small number of studies, methodological heterogeneity and the potential confounding effects of concomitant medication in patients. Despite these limitations, we found strong evidence that selective 5HT3 antagonists (with or without direct α7-nicotinic partial agonist effects) improved sensory gating. Future studies should investigate how this relates to potential improvement in neurocognitive symptoms in antipsychotic naive patients with prodromal or milder symptoms, in order to understand the clinical implications.
昂丹司琼是一种选择性 5-羟色胺(5HT3)受体拮抗剂,目前正在评估其作为精神分裂症辅助治疗药物,以及治疗帕金森病幻觉的新方法。昂丹司琼可逆转感觉门控缺陷,并改善精神病动物模型的视觉感知处理,但目前尚不清楚在多大程度上,临床前研究结果在人类中得到了复制。我们系统地回顾了评估昂丹司琼和其他 5HT3 受体拮抗剂对感觉门控缺陷或感觉处理影响的人类研究。在 11 项符合条件的研究中,有 8 项研究纳入了长期使用抗精神病药物稳定的精神分裂症患者;有 5 项研究使用重复听觉刺激的 P50 抑制反应来测量感觉门控;其他研究包括视觉感知功能测试。三项健康参与者的研究包括视觉感知和感觉运动功能测试。有五项研究一致且强有力地发现,昂丹司琼和曲匹司特(5HT3 拮抗剂和 α7-烟碱受体部分激动剂)改善了精神分裂症患者的感觉门控。曲匹司特还改善了不吸烟患者的持续视觉注意力。5HT3 拮抗剂对其他感觉处理测量指标的影响存在不一致的证据,但由于研究数量少、方法学异质性以及患者同时服用药物的潜在混杂作用,解释受到限制。尽管存在这些局限性,我们发现强有力的证据表明,选择性 5HT3 拮抗剂(具有或不具有直接 α7-烟碱部分激动剂作用)可改善感觉门控。未来的研究应调查这与抗精神病药物初治的前驱期或症状较轻的患者的神经认知症状潜在改善有何关系,以便了解其临床意义。