抗抑郁药治疗痴呆激越的疗效与安全性比较：一项系统评价与网状Meta分析
Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis.
作者信息
Chen Kaili, Li Haiqi, Yang Le, Jiang Yan, Wang Qiaoli, Zhang Jiao, He Jinting
机构信息
Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China.
Department of Endocrinology, Jilin Province People's Hospital, Changchun, China.
出版信息
Front Aging Neurosci. 2023 Mar 3;15:1103039. doi: 10.3389/fnagi.2023.1103039. eCollection 2023.
BACKGROUND
Dementia is a clinical syndrome commonly seen in the elderly individuals. With the prevalence of dementia, the incidence of neuropsychiatric symptoms in dementia patients is increasing annually. Agitation, as one of the neuropsychiatric symptoms, has a serious impact on the quality of life of patients with dementia. Several antidepressant drugs have been shown to be effective for treating agitated behavior symptoms in patients with dementia, but there are no direct comparisons among those drugs. Therefore, we carried out a network meta-analysis (NMA) to examine the efficacy and safety of those antidepressant drugs.
METHODS
We searched eight databases (PubMed, Cochrane Library, Web of Science, Embase, Wanfang Database, China National Knowledge Infrastructure, VIP Database and China biomedical literature service) from their inception to 6 November 2022. Randomized controlled trials (RCTs) reporting the efficacy and safety of antidepressant drugs in treating agitated behavior symptoms in patients with dementia were included in our analysis. The quality assessment was carried out by two researchers individually and the analysis was based on the frequency method.
RESULTS
Twelve articles with 1,146 participants were included in our analysis. Based on the outcome of the agitation score, treatment with citalopram (standardized mean difference, SMD = -0.44, 95% confidence interval, 95% CI = -0.72 to -0.16) showed significant benefits over the placebo group. Treatment with trazodone (odds ratio, OR = 4.58, 95% CI = 1.12-18.69) was associated with a higher risk of total adverse events compared with a placebo treatment.
CONCLUSION
Among the antidepressant drugs included in this study, treatment with citalopram was probably the only optimal intervention, when considering the improvement from baseline to the end of the intervention, and there was not a statistically significant difference in safety when compared with a placebo treatment.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: PROSPERO, CRD42022320932.
背景
痴呆是老年人常见的临床综合征。随着痴呆患病率的上升，痴呆患者神经精神症状的发生率逐年增加。激越作为神经精神症状之一，对痴呆患者的生活质量有严重影响。已有几种抗抑郁药物被证明对治疗痴呆患者的激越行为症状有效，但这些药物之间尚无直接比较。因此，我们进行了一项网络荟萃分析（NMA），以检验这些抗抑郁药物的疗效和安全性。
方法
我们检索了8个数据库（PubMed、Cochrane图书馆、Web of Science、Embase、万方数据库、中国知网、维普数据库和中国生物医学文献服务系统），检索时间从各数据库建库至2022年11月6日。纳入报告抗抑郁药物治疗痴呆患者激越行为症状疗效和安全性的随机对照试验（RCT）进行分析。由两名研究人员分别进行质量评估，并基于频率法进行分析。
结果
我们的分析纳入了12篇文章，共1146名参与者。基于激越评分结果，西酞普兰治疗（标准化均值差，SMD = -0.44，95%置信区间，95%CI = -0.72至-0.16）相对于安慰剂组显示出显著益处。与安慰剂治疗相比，曲唑酮治疗（比值比，OR = 4.58，95%CI = 1.12 - 18.69）与总不良事件风险较高相关。
结论
在本研究纳入的抗抑郁药物中，考虑从干预基线至干预结束的改善情况时，西酞普兰治疗可能是唯一的最佳干预措施，且与安慰剂治疗相比，安全性无统计学显著差异。
系统评价注册
https://www.crd.york.ac.uk/prospero/#recordDetails，标识符：PROSPERO，CRD42022320932。
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