Department of Biology and Pharmacy, Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin Normal University, Yulin, China.
Department of Pharmacy, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China.
Medicine (Baltimore). 2023 Aug 25;102(34):e34687. doi: 10.1097/MD.0000000000034687.
Paroxetine therapy has been used for treatment of patients with depression and Parkinson's disease (dPD) in many clinical studies, but, the effects of paroxetine in dPD patients are not completely understood. The aim of this study was to systematically evaluate the effects of paroxetine therapy on depressive symptom and motor function in the treatment of dPD, in order to confer a reference for clinical practice.
Randomized controlled trials (RCTs) of paroxetine for dPD published up to October, 2022 were retrieved. Standardised mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was measured with the I2 test. The outcomes of interest were as follows: the efficacy, Hamilton depression rating scale score, unified Parkinson's disease rating scale score, Hamilton anxiety rating scale score or adverse events.
Thirty-four RCTs with 2819 participants were included. Compared with control group, the pooled effects of paroxetine therapy on depression were (22 trials; OR 3.62, 95% CI 2.63 to 4.98, P < .00001) for antidepressant response (25 trials; SMD -2.14, 95% CI -2.73 to -1.56, P < .00001) for Hamilton depression rating scale score, the pooled effects of paroxetine therapy on motor function were (10 trials; OR 4.63, 95% CI 3.15 to 6.79, P < .00001) for anti-PD efficacy (18 trials; SMD -2.02, 95% CI -2.48 to -1.55, P < .00001) for total unified Parkinson's disease rating scale score. The Hamilton anxiety rating scale score showed significant decrease in the paroxetine treatment group compared to control group (10 trials; SMD -1.93, 95% CI -2.65 to -1.22, P < .00001). In addition, paroxetine therapy reduced the number of any adverse events obviously in dPD patients (twenty trials; OR 0.42, 95% CI 0.31 to 0.57, P < .00001).
Paroxetine therapy has clinical benefits for improvement of depressive symptom and motor function in dPD patients, moreover, it is of high drug safety. Further well-designed, multi-center RCTs needed to identify these findings.
在许多临床研究中，帕罗西汀疗法已被用于治疗抑郁症和帕金森病（dPD）患者，但帕罗西汀在 dPD 患者中的作用尚不完全清楚。本研究旨在系统评价帕罗西汀治疗 dPD 患者的抑郁症状和运动功能的疗效，为临床实践提供参考。
检索截至 2022 年 10 月发表的帕罗西汀治疗 dPD 的随机对照试验（RCT）。采用标准化均数差（SMD）、比值比（OR）和 95%置信区间（CI）进行计算，并采用 I2 检验测量异质性。主要结局指标如下：疗效、汉密尔顿抑郁量表评分、统一帕金森病评定量表评分、汉密尔顿焦虑量表评分或不良反应。
共纳入 34 项 RCT，共计 2819 例患者。与对照组相比，帕罗西汀治疗组的抗抑郁疗效（22 项研究；OR 3.62，95%CI 2.63 至 4.98，P<0.00001）、抗抑郁反应（25 项研究；SMD -2.14，95%CI -2.73 至 -1.56，P<0.00001）、汉密尔顿抑郁量表评分、帕金森病疗效（10 项研究；OR 4.63，95%CI 3.15 至 6.79，P<0.00001）、总统一帕金森病评定量表评分（18 项研究；SMD -2.02，95%CI -2.48 至 -1.55，P<0.00001）均有统计学意义。与对照组相比，帕罗西汀治疗组的汉密尔顿焦虑量表评分明显下降（10 项研究；SMD -1.93，95%CI -2.65 至 -1.22，P<0.00001）。此外，帕罗西汀治疗可明显减少 dPD 患者的任何不良反应发生（20 项研究；OR 0.42，95%CI 0.31 至 0.57，P<0.00001）。
帕罗西汀治疗可改善 dPD 患者的抑郁症状和运动功能，且具有较高的药物安全性。需要进一步设计良好、多中心的 RCT 来验证这些发现。
