氯氮平耐药性的增强策略:一项系统回顾和荟萃分析。

IF 3.8 4区 医学 Q1 Medicine
Sandeep Grover, Siddharth Sarkar, Swapnajeet Sahoo
{"title":"氯氮平耐药性的增强策略:一项系统回顾和荟萃分析。","authors":"Sandeep Grover,&nbsp;Siddharth Sarkar,&nbsp;Swapnajeet Sahoo","doi":"10.1017/neu.2022.30","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Several augmentation strategies have been used to improve symptomatology in patients not adequately responding to clozapine. Several randomised controlled trials (RCTs) have evaluated the efficacy of different strategies to augment clozapine. This systematic review and meta-analysis reviewed the available RCTs that have evaluated the clinical efficacy of various pharmacological agents, non-pharmacological strategies (occupational therapy, cognitive behaviour therapy), and somatic treatment [electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation, etc.)] as augmenting agents to clozapine.</p><p><strong>Methods: </strong>Data were extracted using standard procedures, and risk of bias was evaluated. Effect sizes were computed for the individual studies.</p><p><strong>Results: </strong>Forty-five clinical trials were evaluated. The pooled effect size for various antipsychotic medications was 0.103 (95% CI: 0.288-0.493, <i>p</i> < 0.001); when the effect size was evaluated for specific antipsychotics for which more than one trial was available, the effect size for risperidone was -0.27 and that for aripiprazole was 0.57. The effect size for lamotrigine was 0.145, and that for topiramate was 0.392. The effect size for ECT was 0.743 (CI: 0.094-1.392). Risk of bias was low (mean Jadad score - 3.93). Largest effect sizes were seen for mirtazapine (effect size of 5.265). Most of the studies can be considered underpowered and limited by small sample sizes.</p><p><strong>Conclusions: </strong>To conclude, based on the findings of the present systematic review and meta-analysis, it can be said that compared to other treatment strategies, clozapine non-responsive patients respond maximum to mirtazapine followed by ECT.</p>","PeriodicalId":7066,"journal":{"name":"Acta Neuropsychiatrica","volume":"35 2","pages":"65-75"},"PeriodicalIF":3.8000,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"3","resultStr":"{\"title\":\"Augmentation strategies for clozapine resistance: a systematic review and meta-analysis.\",\"authors\":\"Sandeep Grover,&nbsp;Siddharth Sarkar,&nbsp;Swapnajeet Sahoo\",\"doi\":\"10.1017/neu.2022.30\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Several augmentation strategies have been used to improve symptomatology in patients not adequately responding to clozapine. Several randomised controlled trials (RCTs) have evaluated the efficacy of different strategies to augment clozapine. This systematic review and meta-analysis reviewed the available RCTs that have evaluated the clinical efficacy of various pharmacological agents, non-pharmacological strategies (occupational therapy, cognitive behaviour therapy), and somatic treatment [electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation, etc.)] as augmenting agents to clozapine.</p><p><strong>Methods: </strong>Data were extracted using standard procedures, and risk of bias was evaluated. Effect sizes were computed for the individual studies.</p><p><strong>Results: </strong>Forty-five clinical trials were evaluated. The pooled effect size for various antipsychotic medications was 0.103 (95% CI: 0.288-0.493, <i>p</i> < 0.001); when the effect size was evaluated for specific antipsychotics for which more than one trial was available, the effect size for risperidone was -0.27 and that for aripiprazole was 0.57. The effect size for lamotrigine was 0.145, and that for topiramate was 0.392. The effect size for ECT was 0.743 (CI: 0.094-1.392). Risk of bias was low (mean Jadad score - 3.93). Largest effect sizes were seen for mirtazapine (effect size of 5.265). Most of the studies can be considered underpowered and limited by small sample sizes.</p><p><strong>Conclusions: </strong>To conclude, based on the findings of the present systematic review and meta-analysis, it can be said that compared to other treatment strategies, clozapine non-responsive patients respond maximum to mirtazapine followed by ECT.</p>\",\"PeriodicalId\":7066,\"journal\":{\"name\":\"Acta Neuropsychiatrica\",\"volume\":\"35 2\",\"pages\":\"65-75\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2023-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Neuropsychiatrica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1017/neu.2022.30\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neuropsychiatrica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1017/neu.2022.30","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 3

摘要

背景:几种增强策略已被用于改善对氯氮平反应不充分的患者的症状。几项随机对照试验(rct)评估了不同策略增加氯氮平的疗效。本系统综述和荟萃分析回顾了现有的随机对照试验,这些随机对照试验评估了各种药物、非药物策略(职业治疗、认知行为治疗)和躯体治疗[电痉挛治疗(ECT)、重复经颅磁刺激等]作为氯氮平的增强剂的临床疗效。方法:采用标准程序提取数据,并评估偏倚风险。计算了各个研究的效应量。结果:共评价了45项临床试验。各种抗精神病药物的综合效应值为0.103 (95% CI: 0.288 ~ 0.493, p < 0.001);当评估有多个试验可用的特定抗精神病药物的效应量时,利培酮的效应量为-0.27,阿立哌唑的效应量为0.57。拉莫三嗪的效应量为0.145,托吡酯的效应量为0.392。ECT的效应量为0.743 (CI: 0.094-1.392)。偏倚风险低(平均Jadad评分- 3.93)。米氮平的效应量最大(效应量为5.265)。大多数研究都被认为是动力不足和样本量小的限制。结论:综上所述,根据本系统综述和荟萃分析的结果,可以说,与其他治疗策略相比,氯氮平无反应的患者对米氮平后ECT的反应最大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Augmentation strategies for clozapine resistance: a systematic review and meta-analysis.

Background: Several augmentation strategies have been used to improve symptomatology in patients not adequately responding to clozapine. Several randomised controlled trials (RCTs) have evaluated the efficacy of different strategies to augment clozapine. This systematic review and meta-analysis reviewed the available RCTs that have evaluated the clinical efficacy of various pharmacological agents, non-pharmacological strategies (occupational therapy, cognitive behaviour therapy), and somatic treatment [electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation, etc.)] as augmenting agents to clozapine.

Methods: Data were extracted using standard procedures, and risk of bias was evaluated. Effect sizes were computed for the individual studies.

Results: Forty-five clinical trials were evaluated. The pooled effect size for various antipsychotic medications was 0.103 (95% CI: 0.288-0.493, p < 0.001); when the effect size was evaluated for specific antipsychotics for which more than one trial was available, the effect size for risperidone was -0.27 and that for aripiprazole was 0.57. The effect size for lamotrigine was 0.145, and that for topiramate was 0.392. The effect size for ECT was 0.743 (CI: 0.094-1.392). Risk of bias was low (mean Jadad score - 3.93). Largest effect sizes were seen for mirtazapine (effect size of 5.265). Most of the studies can be considered underpowered and limited by small sample sizes.

Conclusions: To conclude, based on the findings of the present systematic review and meta-analysis, it can be said that compared to other treatment strategies, clozapine non-responsive patients respond maximum to mirtazapine followed by ECT.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Acta Neuropsychiatrica
Acta Neuropsychiatrica 医学-精神病学
CiteScore
8.50
自引率
5.30%
发文量
30
审稿时长
6-12 weeks
期刊介绍: Acta Neuropsychiatrica is an international journal focussing on translational neuropsychiatry. It publishes high-quality original research papers and reviews. The Journal''s scope specifically highlights the pathway from discovery to clinical applications, healthcare and global health that can be viewed broadly as the spectrum of work that marks the pathway from discovery to global health.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信