阿戈美拉汀与5-HT再摄取抑制剂治疗抑郁症安全性的meta分析

A meta-analysis of safety of agomelatine and SSRIs for depression

目的 比较阿戈美拉汀与选择性5-HT再摄取抑制剂（SSRIs）治疗抑郁症的安全性.方法 检索国内外建库至2016年3月之前的相关文献.检索的数据库包括Pubmed、Cochrance li-brary、中国知网（CNKI）、万方数据库和维普数据库.由2位研究者独立的通过制定的纳入标准及排除标准筛选文献、评估质量及提取数据.采用RevMan 5.3.5软件进行合并分析.结果 共检索到87篇文献,最终纳入英文文献9篇,中文文献2篇.分析结果显示：阿戈美拉汀失眠（RR：0.40,95％ CI：[0.17,0.92],P=0.03）和性功能障碍（RR：0.13,95％ CI：[0.04,0.39],P=0.0003）的发生风险低于帕罗西汀,恶心呕吐的发生风险低于氟西汀（RR：0.68,95％ CI：[0.48,0.96],P=0.03）、帕罗西汀（RR：0.37,95％ CI：[0.25,0.55],P＜0.01）,多汗（RR：0.34,95％ CI：[0.13,0.85,P=0.02）和头痛（RR：0.63,95％ CI：[0.43,0.91],P=0.01）发生风险低于艾司西酞普兰,差异有统计学意义;但嗜睡发生风险高于舍曲林（RR：4.65,95％ CI：[1.02,21.16],P=0.05）,便秘的发生风险高于艾司西酞普兰（RR：3.46,95％ CI：[1.16,10.36],P=0.03）,差异有统计学意义;而口干与腹泻发生风险与SSRIs比较均无显著性差异.结论 阿戈美拉汀与SSRIs类药物的安全性各有利弊,目前证据显示阿戈美拉汀的安全性好于帕罗西汀,与艾司西酞普兰比较各有优劣.阿戈美拉汀与氟西汀、舍曲林安全性比较的证据尚待进一步探究.

Objective To compare the safety of agomelatine and selective serotonin reuptake inhibitors （SSRIs） in the treatment of depression.Methods Retrieved literatures in the database at home and abroad from the built of the databases to March in 2016.The databases included Pubmed,Cochrance library,CNKI,Wanfang database and VIP database.Two researchers selected literatures,evaluated quality and extracted data independeatly.5.3.5 RevMan software was used to analyze.Result 87 literatures were retrieved,and nine English literatures and two Chinese literatures were included.Agomelatine had a lower risk than paroxetine in insomnia （RR：0.40,95% CI：[0.17,0.92],P=0.03） and sexual dysfunction （RR：0.13,95% CI：[0.04,0.39],P=0.0003）,than fluoxetine（RR：0.68,95% CI：[0.48,0.96],P=0.03） and paroxetine（RR：0.37,95% CI：[0.25,0.55],P〈0.01） in nausea and vomiting,and than escitalopram in sweating（RR：0.34,95% CI：[0.13,0.85],P=0.02） and headaches（RR：0.63,95% CI：[0.43,0.91],P=0.01）.The difference of them was statistically significant.Agomelatine had a higher risk than sertraline （RR：4.65,95% CI：[1.02,21.16],P=0.05） in drowsiness,and than escitalopram in constipation （RR：3.46,95% CI：[1.16,10.36],P=0.03）,the difference was statistically significant too.Compared agomelatine and SSRIs,the occurrence risk of dry mouth and diarrhea were no significant difference.Conclusion Both agomelatine and selective serotonin reuptake inhibitors （SSRIs） had its pros and cons in terms of safety.Safety of agomelatine is better than paroxetine.Agomelatine and escitalopram had its own advantages and disadvantages respectively in safety.The evidence of the safety among agomelatine,fluoxetine and sertraline need further explore.