Zhang Xinyan, Cai Yuchun, Hu Xiaowen, Lu Christine Y, Nie Xiaoyan, Shi Luwen
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
Front Psychiatry. 2022 Jun 24;13:922648. doi: 10.3389/fpsyt.2022.922648. eCollection 2022.
We aimed to compare the efficacy, acceptability, and tolerability of vortioxetine in the treatment of Major Depressive Disorder (MDD) in adults.
We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and www.ClinicalTrials.gov for randomized controlled trials that examined vortioxetine vs. placebo or other antidepressants for the treatment of MDD from database inception to August 30, 2021, using keywords Vortioxetine, Brintellix, Trintellix, LuAA21004, major depressive disorder, mood disorder, affective disorder, and MDD. We identified 789 publications after removing duplicates. After screening, 20 eligible randomized controlled trials were identified, of which 19 were included in the final meta-analysis. We included adults (aged 18 years and older) with a primary diagnosis of MDD. Two review authors independently selected the studies and extracted data. We extracted data on study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy, acceptability, and tolerability. Analyses were performed using random-effects models, and outcomes were pooled as risk ratios (RRs) and standardized mean differences (SMDs).
In total, 20 studies (8,547 participants) met the inclusion criteria. Vortioxetine outperformed the placebo in efficacy outcomes, including response (RR 1.35, 95% CI 1.23-1.48; < 0.001), remission (RR 1.33, 95% CI 1.17-1.52; < 0.001), and cognitive function (SMD 0.34, 95% CI 0.16-0.52; = 0.0003). Compared with the serotonin noradrenaline reuptake inhibitors (SNRIs), vortioxetine had better tolerability (RR 0.90, 95% CI 0.86-0.94; < 0.001) but no significant difference in response (RR 0.91, 95%CI 0.82-1.00; = 0.06) or remission (RR: 0.99, 95% CI 0.81-1.20, = 0.88). Vortioxetine had no difference in response (RR 1.08, 95% CI 0.88-1.32; = 0.46), remission (RR 1.00, 95% CI 0.41-2.44; = 1.00) comparing with selective serotonin reuptake inhibitors (SSRIs).
Vortioxetine is more advantageous over placebo in treating MDD among adults, but no significant difference compared to SNRIs and SSRIs in general.
https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021278355, identifier: CRD42021278355.
我们旨在比较伏硫西汀治疗成人重度抑郁症（MDD）的疗效、可接受性和耐受性。
我们检索了PubMed、Embase、科学网、Cochrane临床对照试验中心注册库（CENTRAL）以及www.ClinicalTrials.gov，以查找从数据库建立至2021年8月30日期间，考察伏硫西汀与安慰剂或其他抗抑郁药治疗MDD的随机对照试验，使用的关键词为伏硫西汀、Brintellix、Trintellix、LuAA21004、重度抑郁症、心境障碍、情感障碍和MDD。去除重复文献后，我们识别出789篇出版物。经过筛选，确定了20项符合条件的随机对照试验，其中19项纳入最终的荟萃分析。我们纳入了原发性诊断为MDD的成年人（年龄18岁及以上）。两位综述作者独立选择研究并提取数据。我们提取了关于研究特征、参与者特征、干预细节以及疗效、可接受性和耐受性方面的结局指标的数据。采用随机效应模型进行分析，结局合并为风险比（RRs）和标准化均数差（SMDs）。
共有20项研究（8547名参与者）符合纳入标准。伏硫西汀在疗效结局方面优于安慰剂，包括反应（RR 1.35，95%CI 1.23 - 1.48；P < 0.001）、缓解（RR 1.33，95%CI 1.17 - 1.52；P < 0.001）和认知功能（SMD 0.34，95%CI 0.16 - 0.52；P = 0.0003）。与5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）相比，伏硫西汀具有更好的耐受性（RR 0.90，95%CI 0.86 - 0.94；P < 0.001），但在反应（RR 0.91，95%CI 0.82 - 1.00；P = 0.06）或缓解（RR：0.99，95%CI 0.81 - 1.20，P = 0.88）方面无显著差异。与选择性5-羟色胺再摄取抑制剂（SSRIs）相比，伏硫西汀在反应（RR 1.08，95%CI 0.88 - 1.32；P = 0.46）、缓解（RR 1.00，95%CI 0.41 - 2.44；P = 1.00）方面无差异。
在治疗成人MDD方面，伏硫西汀比安慰剂更具优势，但总体上与SNRIs和SSRIs相比无显著差异。
https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021278355，标识符：CRD42021278355。
