添加依匹哌唑治疗重度抑郁症的系统评价

Systematic review of brexpiprazole as add on treatment for major depressive disorder

目的评价添加依匹哌唑治疗重度抑郁症的疗效与安全性。方法检索Pub Med、The Cochrane Library、Embase、中国期刊全文数据库(CNKI)、万方数据库、中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM),获取依匹哌唑添加治疗重度抑郁症的随机对照试验(RCT),采用Rev Man 5.20软件进行Meta分析。结果共纳入4篇RCT,5个研究,重度抑郁患者1 675例。Meta分析结果显示:与安慰剂组相比,添加依匹哌唑组能更有效地降低治疗末期蒙哥马利抑郁评定量表总分[P=0.02,MD=-1.58,95%CI(-2.89,-0.27)],显著提高治疗有效率[P<0.000 01,RR=1.59,95%CI(1.31,1.94)]、缓解率[P=0.000 4,RR=1.55,95%CI(1.22,1.96)],差异均有统计学意义(P<0.05);在严重不良反应、头痛、失眠发生率方面,依匹哌唑组与安慰剂组相当,差异无统计学意义;但在体质量增加[P<0.000 01,RR=4.36,95%CI(2.45,7.77)]和静坐不能[P<0.000 01,RR=3.39,95%CI(2.08,5.51)]发生率,依匹哌唑组显著高于安慰剂组,差异有统计学意义(P<0.01)。结论添加依匹哌唑治疗重度抑郁症疗效较好,但会增加一些不良反应。

Objective Aim to evaluate the efficacy and safety of brexpiprazole as add on treatment for major depressive disorder（MDD）. Methods The randomized controlled trials（RCTs） of brexpiprazole as add on treatment for MDD were searched from Pub Med, The Cochrane Library, Embase, CNKI, Wan Fang, VIP, and CBM. Meta-analysis of the data was performed by using Rve Man 5.2. Results Four RCTs were collected, including five studies and 1 675 patients with MDD. The results of Meta-analysis showed that compared with the placebo group, brexpiprazole group can effectively reduce the total score of MADRS at the end of treatment period [P=0.02, MD=-1.58, 95%CI（-2.89,-0.27）], the response rate [P〈0.000 01, RR=1.59, 95%CI（1.31, 1.94）] and remission rate [P=0.000 4, RR=1.55, 95%CI（1.22, 1.96）] are obviously increased, and all the differences are statistically significant（P〈0.05）; In the incidence of serious adverse event, headache and insomnia, brexpiprazole group and the placebo group have no significant difference（P〈0.05）; In the weight gain [P〈0.000 01, RR=4.36, 95%CI（2.45, 7.77）, P〈0.000 01, RR=3.39, 95%CI（2.08, 5.51）] and the incidence of akathisia [P0.000 01,RR=3.39,95%CI（2.08,5.51）], brexpiprazole group was significantly higher（P〈0.01） than that of the placebo group. Conclusion The therapeutic effect of treatment with the addition of of brexpiprazole on major depressive disorder is better, but it could increase the risk of adverse drug events.