抗抑郁药对抑郁症和焦虑症患者射精功能障碍的影响:系统综述和网络荟萃分析。

IF 3.2 2区 医学 Q1 ANDROLOGY
Andrology Pub Date : 2024-09-30 DOI:10.1111/andr.13770
Qihua Wang, Zhunan Xu, Xiangyu Chen, Li Liu, Xiaoqiang Liu
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引用次数: 0

摘要

简介抗抑郁药可能导致一系列性不良反应(SAEs),其中射精功能障碍(Ejaculation dysfunction,EjD)常常被临床医生忽视。本网络荟萃分析的目的是通过比较各种抗抑郁药的射精障碍发生率并对其进行排序,从而帮助调整用药:方法:从 PubMed、Embase、Scopus、Web of Science、ClinicalTrials.gov 和其他附加记录中检索相关研究。符合条件的随机对照试验(RCT)评估了重度抑郁障碍(MDD)和焦虑症患者服用抗抑郁药后的EjD发生率。研究人员使用几率比(OR)及其 95% 置信区间(CI)对 EjD、勃起功能障碍(ED)、性欲减退(DL)、不良事件(AE)、因不良事件而停药(WDAE)和因缺乏疗效而停药(WDLE)的发生率进行了汇总。累积排序曲线下表面值(SUCRA)有助于对不同抗抑郁药的每种结果的风险进行排序:结果:共纳入了 30 项 RCT,包括 18,157 名患者。所有节点拆分分析的结果均未显示出统计学上的不一致性(P 均大于 0.05)。与安慰剂相比,氯米帕明(OR 42.11,95% CI [9.90,179.08])、WS5570(OR 28.99,95% CI [1.48,568.97])和帕罗西汀(OR 18.63,95% CI [9.33,37.23])具有显著的 EjD 风险。此外,与安慰剂相比,度洛西汀(OR 7.37,95% CI [2.61,20.78])、氯米帕明(OR 5.29,95% CI [1.72,16.25])、帕罗西汀(OR 3.75,95% CI [1.37,10.26])和艾司西酞普兰(OR 3.04,95% CI [1.20,7.71])的ED风险更高。阿戈美拉汀、左米那西普兰、伏替西汀、曲唑酮、维拉佐酮、氟伏沙明和丙咪嗪的EjD发生率与安慰剂相似(P均>0.05)。此外,曲唑酮、维拉唑酮和伏替西汀在每种 SAEs(EjD、ED 和 DL)中的 SUCRA 值均居前五位,而阿戈美拉汀可能是 EjD 和 DL 的替代药物。考虑到AE、WDAE和WDLE,维拉唑酮在所有这些方面的表现似乎更令人满意:结论:对于服用抗抑郁药后出现 SAE 的患者,曲唑酮、伏替西汀、维拉佐酮和阿戈美拉汀是替代抗抑郁药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of antidepressants on ejaculation dysfunction in patients with depression and anxiety: A systematic review and network meta-analysis.

Introduction: Antidepressants may lead to a series of sexual adverse effects (SAEs), among which ejaculation dysfunction (EjD) is often overlooked by clinicians. The purpose of the present network meta-analysis was to assist drug adjustment by comparing and ranking the incidence of EjD among various antidepressants.

Methods: Relevant studies were retrieved from PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov, and other additional records. Eligible randomized controlled trials (RCTs) assessed the rate of EjD in patients with major depressive disorder (MDD) and anxiety disorder after taking anti-depressants. The incidences of EjD, erectile dysfunction (ED), decreased libido (DL), adverse events (AE), withdrawal due to adverse events (WDAE) and withdrawal due to lack of efficacy (WDLE) were pooled using odds ratio (OR) with their 95% confidence intervals (CI). The values of surface under the cumulative ranking curve (SUCRA) helped to rank the risk of each outcome in different antidepressants.

Results: Thirty RCTs comprising 18,157 patients were included. Results of all node-splitting analysis demonstrated no statistical inconsistency (all P > 0.05). Clomipramine (OR 42.11, 95% CI [9.90, 179.08]), WS5570 (OR 28.99, 95% CI [1.48, 568.97]) and paroxetine (OR 18.63, 95% CI [9.33, 37.23]) had significant risk of EjD comparing to placebo. Additionally, duloxetine (OR 7.37, 95% CI [2.61, 20.78]), clomipramine (OR 5.29, 95% CI [1.72, 16.25]), paroxetine (OR 3.75, 95% CI [1.37, 10.26]) and escitalopram (OR 3.04, 95% CI [1.20, 7.71]) presented higher risk of ED comparing to placebo. Agomelatine, levomilnacipran, vortioxetine, trazodone, vilazodone, fluvoxamine and imipramine exhibited similar incidence of EjD with placebo (all P > 0.05). Besides, trazodone, vilazodone and vortioxetine had the top-five SUCRA values in each of SAEs (EjD, ED and DL), and agomelatine might be alternative in EjD and DL. Considering about AE, WDAE and WDLE, vilazodone appeared to offer more satisfactory performance across all these aspects.

Conclusions: For patients undergoing SAEs following the administration of antidepressants, trazodone, vortioxetine, vilazodone and agomelatine are alternative antidepressants.

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来源期刊
Andrology
Andrology ANDROLOGY-
CiteScore
9.10
自引率
6.70%
发文量
200
期刊介绍: Andrology is the study of the male reproductive system and other male gender related health issues. Andrology deals with basic and clinical aspects of the male reproductive system (gonads, endocrine and accessory organs) in all species, including the diagnosis and treatment of medical problems associated with sexual development, infertility, sexual dysfunction, sex hormone action and other urological problems. In medicine, Andrology as a specialty is a recent development, as it had previously been considered a subspecialty of urology or endocrinology
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