右美沙芬治疗抑郁症:临床试验有效性和安全性的系统评价。

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY
CNS drugs Pub Date : 2023-10-01 Epub Date: 2023-10-04 DOI:10.1007/s40263-023-01032-5
Dania Akbar, Taeho Greg Rhee, Felicia Ceban, Roger Ho, Kayla M Teopiz, Bing Cao, Mehala Subramaniapillai, Angela T H Kwan, Joshua D Rosenblat, Roger S McIntyre
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引用次数: 0

摘要

背景:相当一部分患有严重抑郁障碍(MDD)的成年人对目前临床实践中使用的治疗方法(如第一代单胺类抗抑郁药)没有反应。目的:本系统综述的目的是评估NMDA受体拮抗剂右美沙芬和安非他酮联合应用AXS-05治疗成人MDD的疗效、安全性和作用机制。方法:我们在PubMed、Embase、Google Scholar和ClinicalTrials.gov上搜索关于AXS-05对MDD患者疗效和/或安全性的最新研究。搜索词包括:“AXS-05”或“右美沙芬和安非他酮”和“抑郁症”。对从数据库建立到2023年1月的研究进行了评估。使用Cochrane偏倚风险工具评估偏倚风险。结果:检索得到54项研究,其中包括5项。所有研究的偏倚风险都很低。抑郁症严重程度,与安慰剂对照组相比,Montgomery-Åsberg抑郁评定量表(MADRS)在治疗后1周显著降低(LS平均差异2.2;95%CI 0.6-3.9;p=0.007),在治疗后2周与活动对照组相比显著降低(LS-平均差异4.7;95%CI 0.6-8.8;p=0.024)月,平均MADRS评分较基线降低23分。临床缓解率和缓解率在第1周也有所改善,并维持了12个月。该治疗耐受性良好,报告了一些短暂的不良事件。结论:目前的证据表明,右美沙芬和安非他酮联合治疗成人MDD是一种耐受性良好、快速有效的治疗选择。AXS-05的初步成功支持谷氨酸和西格玛1信号在MDD病理生理学中的机制作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Dextromethorphan-Bupropion for the Treatment of Depression: A Systematic Review of Efficacy and Safety in Clinical Trials.

Dextromethorphan-Bupropion for the Treatment of Depression: A Systematic Review of Efficacy and Safety in Clinical Trials.

Background: A significant proportion of adults with major depressive disorder (MDD) do not respond to treatments which are currently used in clinical practice such as first-generation monoamine-based antidepressants.

Objectives: The objective of this systematic review was to assess the efficacy, safety, and mechanisms of action of AXS-05, a combination of the NMDA-receptor antagonist dextromethorphan with bupropion, in adults with MDD.

Methods: We searched PubMed, Embase, Google Scholar, and ClinicalTrials.gov for current studies reporting on efficacy and/or safety of AXS-05 in patients with MDD. The search terms included: "AXS-05" OR "dextromethorphan and bupropion" AND "depression". Studies from database inception to January 2023 were evaluated. Risk of bias was assessed using the Cochrane Risk of Bias tool.

Results: The search yielded 54 studies of which 5 were included. All studies had low risk of bias. Depression severity, measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) significantly decreased as early as 1-week post-treatment from baseline when compared to a placebo-controlled group (LS mean difference 2.2; 95% CI 0.6-3.9; p = 0.007) and at 2 weeks compared to an active control group (LS mean difference 4.7; 95% CI 0.6-8.8; p = 0.024). Treatment efficacy could be maintained for up to 12 months with mean MADRS score reduction of 23 points from baseline. Clinical remission and response rates also improved at week 1 and were maintained for 12 months. The treatment was well-tolerated, with some transient adverse events reported.

Conclusion: Current evidence suggests that the combination of dextromethorphan and bupropion is a well-tolerated, rapid-acting treatment option for adults with MDD. Initial success with AXS-05 supports the mechanistic role of glutamatergeric and sigma 1 signaling in the pathophysiology of MDD.

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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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