抗炎药物治疗重度抑郁症的疗效与可接受性：一项系统评价与荟萃分析
Efficacy and acceptability of anti-inflammatory agents in major depressive disorder: a systematic review and meta-analysis.
作者信息
Du Yue, Dou Yikai, Wang Min, Wang Yu, Yan Yushun, Fan Huanhuan, Fan Ningdan, Yang Xiao, Ma Xiaohong
机构信息
Mental health center and laboratory of psychiatry, West China Hospital of Sichuan University, Chengdu, China.
出版信息
Front Psychiatry. 2024 May 28;15:1407529. doi: 10.3389/fpsyt.2024.1407529. eCollection 2024.
BACKGROUND
Anti-inflammatory agents have emerged as a potential new therapy for major depressive disorder (MDD). In this meta-analysis, our aim was to evaluate the antidepressant effect of anti-inflammatory agents and compare their efficacy.
METHODS
We conducted a comprehensive search across multiple databases, including PubMed, Embase, Web of Science, Cochrane Review, Cochrane Trial, and ClinicalTrials.gov, to identify eligible randomized clinical trials. The primary outcome measures of our meta-analysis were efficacy and acceptability, while the secondary outcome measures focused on remission rate and dropout rate due to adverse events. We used odds ratio (OR) and 95% confidence interval (95% CI) to present our results.
RESULTS
A total of 48 studies were included in our analysis. In terms of efficacy, anti-inflammatory agents demonstrated a significant antidepressant effect compared to placebo (OR = 2.04, 95% CI: 1.41-2.97, p = 0.0002). Subgroup analyses revealed that anti-inflammatory agents also exhibited significant antidepressant effects in the adjunctive therapy subgroup (OR = 2.17, 95% CI: 1.39-3.37, p = 0.0006) and in MDD patients without treatment-resistant depression subgroup (OR = 2.33, 95% CI: 1.53-3.54, p < 0.0001). Based on the surface under the cumulative ranking curve (SUCRA) value of network meta-analysis, nonsteroidal anti-inflammatory drugs (NSAIDs) (SUCRA value = 81.6) demonstrated the highest acceptability among the included anti-inflammatory agents.
CONCLUSION
In summary, our meta-analysis demonstrates that anti-inflammatory agents have significant antidepressant effects and are well-accepted. Furthermore, adjunctive therapy with anti-inflammatory agents proved effective in treating MDD. Among the evaluated anti-inflammatory agents, NSAIDs exhibited the highest acceptability, although its efficacy is comparable to placebo.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=422004), identifier CRD42023422004.
背景
抗炎药物已成为治疗重度抑郁症（MDD）的一种潜在新疗法。在这项荟萃分析中，我们的目的是评估抗炎药物的抗抑郁作用并比较它们的疗效。
方法
我们对多个数据库进行了全面检索，包括PubMed、Embase、科学网、Cochrane系统评价、Cochrane对照试验中心注册库和美国国立医学图书馆临床试验注册库，以确定符合条件的随机临床试验。我们荟萃分析的主要结局指标是疗效和可接受性，次要结局指标则集中在缓解率和因不良事件导致的脱落率。我们使用比值比（OR）和95%置信区间（95%CI）来呈现结果。
结果
我们的分析共纳入48项研究。在疗效方面，与安慰剂相比，抗炎药物显示出显著的抗抑郁作用（OR = 2.04，95%CI：1.41 - 2.97，p = 0.0002）。亚组分析显示，抗炎药物在辅助治疗亚组（OR = 2.17，95%CI：1.39 - 3.37，p = 0.0006）和无难治性抑郁症的MDD患者亚组（OR = 2.33，95%CI：1.53 - 3.54，p < 0.0001）中也表现出显著的抗抑郁作用。基于网络荟萃分析的累积排序曲线下面积（SUCRA）值，非甾体抗炎药（NSAIDs）（SUCRA值 = 81.6）在所纳入的抗炎药物中显示出最高的可接受性。
结论
总之，我们的荟萃分析表明抗炎药物具有显著的抗抑郁作用且耐受性良好。此外，抗炎药物辅助治疗被证明对治疗MDD有效。在所评估的抗炎药物中，NSAIDs表现出最高的可接受性，尽管其疗效与安慰剂相当。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=422004），标识符CRD42023422004。
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