Meyer Rikke, Skov Kenneth, Dhillon Inderjeet Kaur, Olsson Emilie, Graudal Niels Albert, Baandrup Lone, Jürgens Gesche
Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark.
Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
Biomedicines. 2022 Dec 29;11(1):82. doi: 10.3390/biomedicines11010082.
Recommendations for duration of treatment with antipsychotics before considering a switch vary from 2 to 8 weeks, although several studies suggest a rapid onset of action. The objective of this review was to estimate time to onset of action and time to maximum antipsychotic effect of asenapine, olanzapine, quetiapine, and zotepine (pines). We searched bibliographic databases for randomized, placebo-controlled trials in adults with schizophrenia estimating the antipsychotic effect of pines over time. Thirty-five studies including 6331 patients diagnosed with chronic schizophrenia were included. We estimated the standardized mean differences (SMD) of changes in symptom score from baseline to follow-up between intervention and placebo groups across studies using meta-analysis techniques. The summarized effect across all included pines administered as immediate-release formulations showed a statistically significant effect at week 1 (SMD, -0.20 [CI95% -0.28, -0.13]), which increased until week 3 (SMD, -0.42 [CI95% -0.50, -0.34]), after which the effect leveled off (week 6: SMD, -0.53 [CI95% -0.62, -0.44]). The sensitivity analyses of the individual pines confirm this finding, although data sparsity increases variability and limits conclusiveness of these analyses.
在考虑换药之前，抗精神病药物的治疗时长建议从2周到8周不等，尽管多项研究表明其起效迅速。本综述的目的是评估阿立哌唑、奥氮平、喹硫平和氯氮平（“平类药物”）的起效时间和达到最大抗精神病效果的时间。我们在文献数据库中检索了针对成人精神分裂症患者的随机、安慰剂对照试验，以评估“平类药物”随时间推移的抗精神病效果。纳入了35项研究，共6331例被诊断为慢性精神分裂症的患者。我们使用荟萃分析技术估算了各研究中干预组与安慰剂组从基线到随访期间症状评分变化的标准化平均差异（SMD）。所有纳入的速释剂型“平类药物”的汇总效应在第1周显示出统计学显著效果（SMD，-0.20 [95%CI -0.28, -0.13]），该效果持续增加直至第3周（SMD，-0.42 [95%CI -0.50, -0.34]），此后效果趋于平稳（第6周：SMD，-0.53 [95%CI -0.62, -0.44]）。各“平类药物”的敏感性分析证实了这一发现，尽管数据稀疏性增加了变异性并限制了这些分析的结论性。
