Greist J H, Jefferson J W, Kobak K A, Katzelnick D J, Serlin R C
Dean Foundation for Health, Research and Education, Madison, Wis.
Arch Gen Psychiatry. 1995 Jan;52(1):53-60. doi: 10.1001/archpsyc.1995.03950130053006.
Questions have been raised regarding the relative efficacy and tolerability of the different serotonin transport inhibitors in the treatment of obsessive-compulsive disorder. We compared the results from four large multicenter placebo-controlled trials of the serotonin transport inhibitors clomipramine hydrochloride (N = 520), fluoxetine hydrochloride (N = 355), fluvoxamine maleate (N = 320), and sertraline hydrochloride (N = 325) for the treatment of obsessive-compulsive disorder.
Effect size was calculated by subtracting the end-point drug treatment mean change from the end-point placebo mean change and dividing by the end-point pooled change standard deviation. A test for overall differences between effect sizes was conducted, followed by all possible pairwise comparisons. The Yale-Brown Obsessive Compulsive Scale was the primary outcome measure for all four studies.
All four agents were significantly more effective than placebo, with clomipramine significantly more effective than the other three treatments, which did not differ in effect size. A significantly greater percentage of patients treated with clomipramine were rated much or very much improved than were patients treated with fluoxetine, fluvoxamine, or sertraline.
While the results of this meta-analysis support the superiority of clomipramine, head-to-head, double-blind comparisons of these compounds would be the best test of comparative efficacy and tolerability.
关于不同血清素转运抑制剂在治疗强迫症方面的相对疗效和耐受性已引发诸多问题。我们比较了四项大型多中心安慰剂对照试验的结果，这些试验分别使用血清素转运抑制剂盐酸氯米帕明（N = 520）、盐酸氟西汀（N = 355）、马来酸氟伏沙明（N = 320）和盐酸舍曲林（N = 325）来治疗强迫症。
效应大小通过用终点安慰剂平均变化值减去终点药物治疗平均变化值，再除以终点合并变化标准差来计算。对效应大小之间的总体差异进行了检验，随后进行了所有可能的两两比较。耶鲁-布朗强迫症量表是所有四项研究的主要结局指标。
所有四种药物均比安慰剂显著更有效，其中盐酸氯米帕明比其他三种治疗方法显著更有效，而这三种治疗方法在效应大小上没有差异。与接受氟西汀、氟伏沙明或舍曲林治疗的患者相比，接受盐酸氯米帕明治疗的患者中被评为改善很多或非常多的比例显著更高。
虽然这项荟萃分析的结果支持盐酸氯米帕明的优越性，但对这些化合物进行直接的、双盲比较将是比较疗效和耐受性的最佳测试。
