艾司西酞普兰治疗惊恐障碍的疗效和安全性系统评价

Efficacy and Safety of Escitalopram and Paroxetine for Panic Disorder: A Systematic review

目的系统评价艾司西酞普兰与帕罗西汀治疗成人惊恐障碍的疗效与安全性。方法通过计算机检索及手工检索,以艾司西酞普兰(escitalopram)、帕罗西汀(paroxetine)、惊恐障碍(panic disorder)为检索词,全面收集中国知网全文数据库(CNKI)、中国维普全文数据库(VIP)、中国生物医学文献数据库(CBM disc)、万方全文数据库自创刊起关于艾司西酞普兰与帕罗西汀治疗惊恐障碍的临床随机对照试验(RCT)。对最终纳入的RCT按照Cochrane协作网系统评价的方法,严格评价纳入研究质量,对同质性研究采用Revman 5.0.2软件进行统计分析。结果纳入8个RCT,共包括716名受试对象。治疗第1周、第2周和第4周末艾司西酞普兰组的有效性得分均显著高于帕罗西汀组,有统计学意义[第1周末,MD=-1.93,95%CI(-2.68,-1.19),P=0.57;第2周末,MD=-4.6,95%CI(-6.51,-2.69),P<0.000 01;第4周末,MD=-1.2,95%CI(-1.98,-0.43),P=0.35];治疗第6周和第8周后艾司西酞普兰组与帕罗西汀组的有效性差异均无统计学意义[第6周末,MD=-0.74,95%CI(-1.53,0.04),P=0.98;第8周末,MD=-0.55,95%CI(-1.21,0.12),P=0.72];疗程结束后的终末治愈率艾司西酞普兰组与帕罗西汀组的差异无统计学意义[RR=0.89,95%CI(0.72,1.09),P=0.59];在分析的所有不良反应报告中,艾司西酞普兰组与帕罗西汀组所有不良反应项目差异均无统计学意义。结论艾司西酞普兰治疗成人惊恐障碍的长期疗效与帕罗西汀相当,但起效快于帕罗西汀,且具有良好的耐受性和安全性。

Objective To assess the efficacy and safety of escitalopram and paroxetine for treating adult panic disorder. Methods The randomized controlled trials （RCTs） of escitalopram and paroxetine for treating adult panic disorder were retrieved in the China Nation- al Knowledge Internet （CNKI）,CQVIP,Chinese Biomedical Literature Database （CBM）,Wanfang database from their establishment. The quality of the included RCTs was strictly assessed according to the Cochrane collaboration network systematic evaluation method and the homogeneity RCTs were performed the statistical analysis by the RevMan 5.0. 2 software. Results 8 RCTs involving 716 subjects were included. The results of meta analysis showed that the effectiveness scores at the end of 1- week, 2- week and 4- week treatment in the escitalopram group were significantly higher than those in the paroxetine group [at the end of 1-week treatment MD=-1.93, 95%CI （-2.68,-1.19）,P=O. 57;at the end of 2-week treatment MD= -4.6,95%C1（-6.51,-2.69）,P 〈 0.000 01;at the end of 4-week treatment MD=-1.2,95%CI（-1.98,-0.43）,P=0.35].But after 6-week and 8-week treatment there was no statistically significant difference in the effectiveness between the escitalopram group and the paroxetine group [ at the end of 6- week treatment MD= -0.74,95%CI （-1.53,0.04）,P=0.98;at the end of 8-week treatment MD= -0.55,95%CI（-0.72,1.09）, P=0. 72] ;the final cure rate after therapy in the escitalopram group and the paroxetine group had no statistically significant difference [RR=O. 89,95% CI （0.72,1.09）, P=0. 59 ]. Among all the analyzed adverse reactions,the differences of the adverse reaction items had no statistical difference between the escitalopram group and the paroxetine group. Conclusion The long term efficacy of escitalo- pram for treating adult panic disorder is equivalent to that of paroxetine, but is more rapid in effect onset than paroxetine and has bet- ter tolerability and safety.