喹硫平缓释片治疗成人精神分裂症有效性和安全性的Meta分析

Meta-analysis of the efficiency and safety study of extended release quetiapine in the treatment of adult schizophrenia

目的:系统评价喹硫平缓释片治疗成人精神分裂症的疗效及安全性。方法:计算机检索Medline、PubMed、The CochraneLibrary、Embase、中国知网、维普、万方等数据库,收集关于喹硫平缓释片治疗成人精神分裂症的随机对照研究,检索时间为自建库至2019年9月,并对符合纳入标准的文献进行Meta分析。结果:共计纳入12篇文献,Meta分析结果显示:与利培酮相比,喹硫平缓释片在改善PANSS总分(P=0.007)及CGI-S评分(P=0.0008)方面具有显著优势;还可减少失眠的发生(P=0.008),降低高泌乳素血症的发生(P=0.001);但在嗜睡、镇静方面,其作用弱于利培酮。与鲁拉西酮相比,喹硫平缓释片在改善患者PANSS总分、CGI-S评分、增加体重、失眠、头痛、恶心方面无统计学差异,但可以显著降低焦虑的发生(P=0.05)。喹硫平缓释片与普通片在有效性及安全性方面未见明显差异。结论:喹硫平缓释片的疗效与安全性良好,与利培酮及鲁拉西酮相比具有部分优势。但受纳入研究质量及数量的限制,上述研究尚需更多高质量研究加以验证。

Objective: To systematically evaluate the efficiency and safety of extended release quetiapine fumarate (quetiapine XR) in the treatment of adult schizophrenia. Methods: Databases including Medline, PubMed, The Cochrane Library, Embase, CNKI, VIP and WanFang were searched to collect randomized controlled trials (RCTs) about quetiapine XR for adult schizophrenia from the inception to September 2019. Then meta-analysis was performed on included RCTs. Results: A total of 12 RCTs were enrolled in this study. Results of meta-analysis showed that quetiapine XR could significantly reduce the total scores of PANSS (P = 0.007) and CGI-S (P = 0.000 8), the occurrence of insomnia (P = 0.008) and hyperprolactinemia (P = 0.001) compared with risperidone. Whereas, the effect of quetiapine XR on somnolence and sedation was significantly weaker than risperidone. Compared with lurasidone, quetiapine XR showed no significant effect on PANSS total score, CGI-S score, weight increase, insomnia, headache and nausea while quetiapine XR could significantly reduce the occurrence of anxiety (P = 0.05). The efficiency and safety of quetiapine XR were not significantly different from that of quetiapine conventional tablets. Conclusion: Quetiapine XR had good effectivity and safety, which was partly better than risperidone and lurasidone. But more high quality studies are needed to verify this conclusion due to the limitation of the quality and quantity of RCTs involved in this study.