帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性的meta分析

Efficacy and Safety of Paroxetine and Other Selective 5-HT Reuptake Inhibitors: A Meta-analysis

目的评价帕罗西汀与其他选择性5-HT再摄取抑制药的疗效及安全性。方法计算机检索Cochrane图书馆、ISI数据库、中国知网(CNKI)、维普(VIP)、万方数字化期刊数据库,纳入帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性随机对照试验(randomized controlled trial,RCT)、系统评价和meta分析文献,对纳入文献的RCTs进行方法学质量评价和meta分析,参考纳入文献的系统评价和meta分析结论。结果帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性对比分析共纳入15个RCTs。2组抗抑郁总有效率差异有统计学意义(OR=1.45,95%CI=1.01~2.09,P=0.04);治疗2周和6周后HAMD评分差异有统计学意义(MD=-2.04,95%CI=-2.59^-1.49,P<0.000 01;MD=-0.69,95%CI=-1.18^-0.21,P=0.005);治疗6周后药物不良反应发生率差异有统计学意义(OR=0.88,95%CI=0.78~0.99,P=0.04)。结论与其他选择性5-HT再摄取抑制药相比较,帕罗西汀的总有效率及起效速度较低,不良反应发生率较高,其不再推荐为一线抗抑郁药。

OBJECTIVE To evaluate the efficacy and safety of paroxetine and other selective 5-HT reuptake inhibitors. METHODS Cochrane Library, web of science, CNKI, VIP, Wanfang Digital Journal Database were retridved. Systematic review(SR) and meta-analysis or randomized controlled trial(RCT) compared paroxetine with other selective 5-HT reuptake inhibitor efficacy and safety. Methodological quality evaluation and meta-analysis of included RCTs, referenced to SR and meta analysis conclusions. RESULTS A total of 15 RCTs were included in the comparison of efficacy and safety of paroxetine with other selective 5-HT reuptake inhibitors. The total effective rate of antidepression in the 2 groups was statistically significant (OR=1.45, 95%CI=1.01-2.09, P=0.04);the difference in HAMD scores after 2 weeks and 6 weeks of treatment was statistically significant(MD=-2.04, 95%CI=-2.59--1.49, P<0.000 1;MD=-0.69, 95%CI=-1.18--0.21, P=0.005);the difference in adverse reation after 6 weeks of treatment was statistically significant(OR=0.88, 95%CI=0.78-0.99, P=0.04). CONCLUSION Compared with other selective 5-HT reuptake inhibitors, paroxetine has lower total effective rate and onset rate, and higher incidence of adverse reactions, which is no longer recommended as first-line antidepressant.