氟西汀和帕罗西汀在抑郁症急性期治疗中的疗效比较

Assessing the efficacy and acceptability of fluoxetine and paroxetine in acute treating depression

目的采用Meta分析系统评价氟西汀和帕罗西汀在抑郁症急性期治疗中的疗效和可接受性。方法计算机检索CNKI、CBMdisc、Web of Science、Embase、PubMed等数据库以及相关网站,检索时间为2000年1月至2020年4月,检索词包括“帕罗西汀”“氟西汀”和“抑郁症”。无语言限制,纳入帕罗西汀和氟西汀在急性期治疗抑郁症的随机对照试验。使用Cochrane系统评价手册进行风险评估,采用RevMan 5.3进行Meta分析。主要评价指标为响应率,次要评价指标为失访率。结果共纳入11篇随机对照试验,包括2569例抑郁症患者。Meta分析结果显示,在急性治疗期,抑郁症患者对两种药物的响应率差异无统计学意义(OR=1.16,95%CI=0.98~1.38,P=0.08),失访率差异无统计学意义(OR=0.88,95%CI=0.74~1.04,P=0.14)。亚组分析结果说明,在6~8周急性治疗期,帕罗西汀的响应率高于氟西汀;而在12~24周急性治疗期,氟西汀的响应率显著高于帕罗西汀(P=0.006)。结论在急性治疗期,氟西汀和帕罗西汀两组间的响应率和失访率差异均无统计学意义,但帕罗西汀的充足疗程为6~8周,氟西汀的充足疗程为12~24周。

Objective Meta-analysis was conducted to assess the efficacy of fluoxetine versus paroxetine for depression during the acute treatment phase.Methods CNKI,CBM-disc,Web of Science,Embase,PubMed,and other relevant literature were searched from January 2000 to April 2020.The key search terms were"paroxetine""fluoxetine"and"depression".No language restriction was imposed here.The randomized controlled trials were included.The Cochrane system assessment manual was used here to assess the bias risk,and RevMan 5.3 softwar was used to do Metaanalysis.The primary outcome was the response rate,and the secondary outcome was the drop-out rate.Results 11 studies with 2569 patients were Meta-analyzed.During the acute-treatment phase,there was no significantly difference on the response rate(OR=1.16,95%CI=0.98-1.38,P=0.08)and drop-out rate(OR=0.88,95%CI=0.74-1.04,P=0.14)between patients receiving fluoxetine and patients receiving paroxetine.The subgroup analysis showed that patients receiving paroxetine had a higher response rate during the 6-8 weeks treatment period(P=0.22),and patients receiving fluoxetine had a significantly higher response rate during the 12-24 weeks treatment period(P=0.006).Conclusion These results indicated that paroxetine should be preferably prescribed for 6-8 weeks acute-phase treatment periods,while fluoxetine should be preferably prescribed for 12-24 weeks acutephase treatment periods.