Leal Gustavo C, Lima-Araújo Isabel, Roiter David G, Caliman-Fontes Ana Teresa, Mello Rodrigo P, Kapczinski Flávio, Lacerda Acioly L T, Quarantini Lucas C
Laboratório de Neuropsicofarmacologia (LANP), Psychiatry Service, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Universidade Federal da Bahia, Rua Dr. Augusto Viana, s/n-Canela, Salvador, Bahia, 40110-060, Brazil.
Faculdade de Medicina da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Eur Arch Psychiatry Clin Neurosci. 2024 Dec 16. doi: 10.1007/s00406-024-01945-2.
Arketamine (R-ketamine), an enantiomer of ketamine, has historically been less studied than esketamine (S-ketamine) and the racemic mixture. Recent preclinical studies suggest that arketamine may offer prolonged antidepressant effects and a superior safety profile. This scoping review aims to assess and synthesise existing literature on the clinical use of arketamine in humans. This review follows the PRISMA for Scoping Reviews guidelines, with a comprehensive search conducted in PubMed, Embase, ClinicalTrials.gov, and the WHO International Clinical Trials Registry. Eligible studies included those reporting the administration of arketamine to humans. Data were extracted and synthesised descriptively. A total of 20 studies involving 410 subjects were included. Arketamine was primarily investigated for pain management and depression. While early evidence suggests arketamine may be effective in reducing pain, most studies were small and conducted in non-clinical settings. In psychiatry, trials indicate potential antidepressant effects, but results are inconsistent, and some studies remain unpublished. A consistent observation across most studies is arketamine's favourable safety profile, showing lower incidences of dissociative and psychotomimetic effects compared to esketamine and racemic ketamine. Arketamine may have a role in pain management and psychiatry, with a favourable safety profile compared to other forms of ketamine. However, the small scale of many studies limits the generalizability of findings, and results in depression trials are mixed. Larger, well-designed studies, possibly with higher doses, are needed to determine its therapeutic potential and establish its place in clinical practice.
艾氯胺酮（R-氯胺酮）是氯胺酮的一种对映体，与艾司氯胺酮（S-氯胺酮）和消旋混合物相比，其历史研究较少。最近的临床前研究表明，艾氯胺酮可能具有延长的抗抑郁作用和更好的安全性。本综述旨在评估和综合关于艾氯胺酮在人类临床应用的现有文献。本综述遵循《系统综述和范围综述的首选报告项目》（PRISMA）指南，在PubMed、Embase、ClinicalTrials.gov和世界卫生组织国际临床试验注册中心进行了全面检索。符合条件的研究包括那些报告对人类使用艾氯胺酮的研究。数据进行了提取并进行描述性综合。共纳入了20项涉及410名受试者的研究。艾氯胺酮主要用于疼痛管理和抑郁症的研究。虽然早期证据表明艾氯胺酮可能有效减轻疼痛，但大多数研究规模较小且在非临床环境中进行。在精神病学方面，试验表明其具有潜在的抗抑郁作用，但结果不一致，且一些研究尚未发表。大多数研究的一个一致观察结果是艾氯胺酮具有良好的安全性，与艾司氯胺酮和消旋氯胺酮相比，其解离和拟精神病作用的发生率较低。艾氯胺酮可能在疼痛管理和精神病学中发挥作用，与其他形式的氯胺酮相比具有良好的安全性。然而，许多研究规模较小限制了研究结果的普遍性，抑郁症试验的结果也参差不齐。需要进行更大规模、设计良好的研究，可能需要更高的剂量，以确定其治疗潜力并确立其在临床实践中的地位。
