Patlola Saahithh Redddi, Donohoe Gary, McKernan Declan P
Pharmacology & Therapeutics, School of Medicine, National University of Ireland Galway, Ireland.
School of Psychology, National University of Ireland Galway, Ireland.
J Psychiatr Res. 2023 Apr;160:126-136. doi: 10.1016/j.jpsychires.2023.01.042. Epub 2023 Feb 4.
Schizophrenia is a major psychiatric disorder with unknown aetiology. Recent evidence suggests a potential role for cytokines in its pathophysiology and that antipsychotic medication may alter this. While the aetiology of schizophrenia remains only partly understood, an altered immune function representing an important avenue of further discovery. In this systematic review and meta-analysis we focus on the specific effects of second generation antipsychotics risperidone and clozapine on inflammatory cytokines.
A defined systematic search of PubMed and Web of Science databases was performed to identify relevant studies published between Jan 1900 and May 2022. After screening of 2969 papers, 43 studies (27 single-arm and 8 dual-arm) were included that consisted of a total of 1421 patients with schizophrenia in the systematic review. From these, twenty studies (4 dual-arm; 678 patients) had data available on which a meta-analysis could be carried out.
Our meta-analysis showed a significant reduction of pro-inflammatory cytokines post-risperidone treatment in the absence of a similar association with clozapine. Subgroup analyses (First episode v chronic) demonstrated that duration of illness influenced the extent of cytokine alteration; risperidone treatment produced significant cytokine changes (lowered IL-6 and TNF-α) in chronic patients but not in first-episode psychosis (FEP) patients.
Varying treatment effects on cytokines can be observed by the use of different antipsychotic drugs. The cytokine alterations post-treatment are influenced by the specific antipsychotic drugs and patient status. This may explain disease progression in certain patient groups and influence therapeutic choices in the future.
精神分裂症是一种病因不明的主要精神疾病。最近的证据表明细胞因子在其病理生理学中可能起作用，并且抗精神病药物可能会改变这种情况。虽然精神分裂症的病因仍仅部分为人所知，但免疫功能改变是进一步探索的重要途径。在本系统评价和荟萃分析中，我们关注第二代抗精神病药物利培酮和氯氮平对炎性细胞因子的特定影响。
对PubMed和Web of Science数据库进行了明确的系统检索，以识别1900年1月至2022年5月期间发表的相关研究。在筛选了2969篇论文后，纳入了43项研究（27项单臂研究和8项双臂研究），系统评价中共有1421例精神分裂症患者。其中，20项研究（4项双臂研究；678例患者）有可用于进行荟萃分析的数据。
我们的荟萃分析显示，利培酮治疗后促炎细胞因子显著减少，而氯氮平治疗则未观察到类似关联。亚组分析（首发与慢性）表明，病程影响细胞因子改变的程度；利培酮治疗在慢性患者中产生了显著的细胞因子变化（降低了IL-6和TNF-α），但在首发精神病（FEP）患者中未观察到。
使用不同的抗精神病药物可观察到对细胞因子的不同治疗效果。治疗后细胞因子的改变受特定抗精神病药物和患者状态的影响。这可能解释了某些患者群体的疾病进展，并可能影响未来的治疗选择。
