The efficacy of lamotrigine in bipolar disorder: A systematic review and meta-analysis

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2024-05-15 DOI:10.1111/bdi.13452

N. Haenen, A. M. Kamperman, A. Prodan, W. A. Nolen, M. P. Boks, R. Wesseloo

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引用次数: 0

Abstract

Objective

To provide up-to-date clinical guidance on the efficacy of lamotrigine in bipolar disorder (BD).

Methods

Eligible studies were identified during a systematic literature search according to PRISMA-guidelines. We included randomized controlled trials (RCTs) and cohort studies that quantitatively assessed lamotrigine's efficacy in BD. We divided the included studies into three groups: 1. acute treatment of depression, 2. acute treatment of mania and hypomania, and 3. maintenance treatment. Analyses were stratified by control group (placebo vs active comparator) and treatment strategy (monotherapy vs add-on treatment).

Results

We included 20 RCTs (n = 1166 lamotrigine users) and 20 cohort studies (n = 11,141 lamotrigine users). Twenty-four of these studies were included in meta-analyses. During depressive episodes, greater decreases in depressive symptomatology were associated with initiation of lamotrigine as add-on treatment than with placebo (SMD −0.30 [95% CI = −0.51, −0.10], df = 3, p = 0.004). Decreases in depressive symptomatology did not differ significantly between lamotrigine and the active comparator (SMD −0.28 [95% CI = −1.06, 0.50], df = 3, p = 0.488).

As a maintenance treatment, lamotrigine was associated with a significantly lower relapse/recurrence rate than placebo (risk ratio (RR) 0.84 [95% CI = 0.71, 0.99], df = 2, p = 0.037). Relapse/recurrence rates did not differ significantly between lamotrigine and lithium (RR 1.06 [95% CI = 0.89, 1.25], df = 2, p = 0.513). A qualitative assessment of high-quality register-based studies found that lamotrigine was associated with lower hospital admission rates than other commonly used treatment regimes.

Conclusions

There is substantial evidence for the efficacy of lamotrigine in BD, specifically as add-on treatment during acute depressive episodes and as maintenance treatment for preventing relapse and recurrence.

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拉莫三嗪对躁郁症的疗效：系统回顾和荟萃分析。

目的：就拉莫三嗪对双相情感障碍（BD）的疗效提供最新的临床指导：就拉莫三嗪对双相情感障碍（BD）的疗效提供最新的临床指导：根据PRISMA指南，通过系统文献检索确定了符合条件的研究。我们纳入了定量评估拉莫三嗪对躁狂症疗效的随机对照试验（RCT）和队列研究。我们将纳入的研究分为三组：1.抑郁症的急性治疗；2.躁狂症和躁狂症的急性治疗；3.维持治疗。根据对照组（安慰剂与活性比较药）和治疗策略（单药治疗与附加治疗）进行分层分析：我们纳入了 20 项 RCT（n = 1166 名拉莫三嗪使用者）和 20 项队列研究（n = 11141 名拉莫三嗪使用者）。其中24项研究被纳入荟萃分析。在抑郁发作期间，开始使用拉莫三嗪作为附加治疗与安慰剂相比，抑郁症状的减少幅度更大（SMD -0.30 [95% CI = -0.51, -0.10]，df = 3，p = 0.004）。拉莫三嗪与活性比较药在抑郁症状的减少方面没有显著差异（SMD -0.28 [95% CI = -1.06, 0.50], df = 3, p = 0.488）。作为一种维持治疗方法，拉莫三嗪的复发/复发率明显低于安慰剂（风险比 (RR) 0.84 [95% CI = 0.71, 0.99], df = 2, p = 0.037）。拉莫三嗪和锂盐的复发/复发率差异不大（RR 1.06 [95% CI = 0.89, 1.25]，df = 2，p = 0.513）。对高质量登记研究的定性评估发现，与其他常用治疗方案相比，拉莫三嗪的入院率较低：有大量证据表明拉莫三嗪对 BD 具有疗效，特别是作为急性抑郁发作期间的附加治疗和预防复发的维持治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.