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Abstract：
OBJECTIVE: To report the first and largest systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression (TRD) or major depressive disorder(MDD).
METHODS: We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April 2023 for RCT, which evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching for patients with TRD or MDD. Outcomes measured were changes in the Montgomery-Asberg Depression Rating Scale (MADRS), response and remission rate, and serious adverse events.
RESULTS: Five RCTs, including 4480 patients, were included for meta-analysis. Among them, two RCTs were rated as \"high risk\" in three aspects (allocation concealment, blinding of participants and personnel and blinding of outcome assessment) because of the non-blind method, and the quality evaluation of the remaining works of literature was \"low risk\". Augmentation treatment with Aripiprazole (A-ARI) was associated with a significant higher response rate compared with augmentation treatment with bupropion (A-BUP) (RR: 1.15; 95% CI: 1.05, 1.25; P = 0.0007; I2 = 23%). Besides, A-ARI had a significant higher remission rate compared with switching to bupropion (S-BUP) (RR: 1.22; 95% CI: 1.00, 1.49; P = 0.05; I2 = 59%) and A-BUP had a significant higher remission rate compared with S-BUP (RR: 1.20; 95% CI: 1.06, 1.36; P = 0.0004; I2 = 0%). In addition, there was no significant difference in remission rate(RR: 1.05; 95% CI: 0.94, 1.17; P = 0.42; I2 = 33%), improvement of MADRS(WMD: -2.07; 95% CI: -5.84, 1.70; P = 0.28; I2 = 70%) between A-ARI and A-BUP. No significant difference was observed in adverse events and serious adverse events among the three treatment strategies.
CONCLUSIONS: A-ARI may be a better comprehensive antidepressant treatment strategy than A-BUP or S-BUP for patients with TRD or MDD. More large-scale, multi-center, double-blind RCTs are needed to further evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching treatment strategies.
METHODS: We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April 2023 for RCT, which evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching for patients with TRD or MDD. Outcomes measured were changes in the Montgomery-Asberg Depression Rating Scale (MADRS), response and remission rate, and serious adverse events.
RESULTS: Five RCTs, including 4480 patients, were included for meta-analysis. Among them, two RCTs were rated as \"high risk\" in three aspects (allocation concealment, blinding of participants and personnel and blinding of outcome assessment) because of the non-blind method, and the quality evaluation of the remaining works of literature was \"low risk\". Augmentation treatment with Aripiprazole (A-ARI) was associated with a significant higher response rate compared with augmentation treatment with bupropion (A-BUP) (RR: 1.15; 95% CI: 1.05, 1.25; P = 0.0007; I2 = 23%). Besides, A-ARI had a significant higher remission rate compared with switching to bupropion (S-BUP) (RR: 1.22; 95% CI: 1.00, 1.49; P = 0.05; I2 = 59%) and A-BUP had a significant higher remission rate compared with S-BUP (RR: 1.20; 95% CI: 1.06, 1.36; P = 0.0004; I2 = 0%). In addition, there was no significant difference in remission rate(RR: 1.05; 95% CI: 0.94, 1.17; P = 0.42; I2 = 33%), improvement of MADRS(WMD: -2.07; 95% CI: -5.84, 1.70; P = 0.28; I2 = 70%) between A-ARI and A-BUP. No significant difference was observed in adverse events and serious adverse events among the three treatment strategies.
CONCLUSIONS: A-ARI may be a better comprehensive antidepressant treatment strategy than A-BUP or S-BUP for patients with TRD or MDD. More large-scale, multi-center, double-blind RCTs are needed to further evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching treatment strategies.
摘要：
目的：报告首次也是最大的系统评价和荟萃分析随机对照试验（RCT），以评估阿立哌唑或安非他酮增强和转换治疗难治性抑郁症（TRD）或重度抑郁症（MDD）患者的疗效和安全性。
方法：我们通过PubMed进行了系统的文献检索，Embase,WebofScience,和Cochrane直到2023年4月进行RCT，评估了阿立哌唑或安非他酮增强和转换对TRD或MDD患者的疗效和安全性。测量的结果是蒙哥马利-阿斯伯格抑郁量表(MADRS)的变化，反应和缓解率，和严重不良事件。
结果：五个RCT，包括4480名患者，纳入荟萃分析。其中,两个RCT在三个方面被评为“高风险”(分配隐藏，由于非盲法，参与者和人员的盲法和结果评估的盲法)，其余文学作品的质量评价为“低风险”。与安非他酮（A-BUP）增强治疗相比，阿立哌唑（A-ARI）增强治疗的缓解率明显更高（RR：1.15；95％CI：1.05，1.25；P=0.0007；I2=23％）。此外,与改用安非他酮（S-BUP）相比，A-ARI的缓解率明显更高（RR：1.22；95％CI：1.00，1.49；P=0.05；I2=59％），A-BUP的缓解率明显高于S-BUP（RR：1.20；95％CI：1.06，1.36；P=0.0004；I2=0％）。此外,缓解率无显著差异(RR:1.05;95%CI:0.94,1.17;P=0.42;I2=33%),A-ARI和A-BUP之间MADRS(WMD:-2.07;95%CI:-5.84,1.70;P=0.28;I2=70%)的改善。在三种治疗策略中，不良事件和严重不良事件没有观察到显着差异。
结论：对于TRD或MDD患者，A-ARI可能是比A-BUP或S-BUP更好的综合抗抑郁治疗策略。更大规模，多中心,需要双盲RCT来进一步评估阿立哌唑或安非他酮增强和转换治疗策略的有效性和安全性.
方法：我们通过PubMed进行了系统的文献检索，Embase,WebofScience,和Cochrane直到2023年4月进行RCT，评估了阿立哌唑或安非他酮增强和转换对TRD或MDD患者的疗效和安全性。测量的结果是蒙哥马利-阿斯伯格抑郁量表(MADRS)的变化，反应和缓解率，和严重不良事件。
结果：五个RCT，包括4480名患者，纳入荟萃分析。其中,两个RCT在三个方面被评为“高风险”(分配隐藏，由于非盲法，参与者和人员的盲法和结果评估的盲法)，其余文学作品的质量评价为“低风险”。与安非他酮（A-BUP）增强治疗相比，阿立哌唑（A-ARI）增强治疗的缓解率明显更高（RR：1.15；95％CI：1.05，1.25；P=0.0007；I2=23％）。此外,与改用安非他酮（S-BUP）相比，A-ARI的缓解率明显更高（RR：1.22；95％CI：1.00，1.49；P=0.05；I2=59％），A-BUP的缓解率明显高于S-BUP（RR：1.20；95％CI：1.06，1.36；P=0.0004；I2=0％）。此外,缓解率无显著差异(RR:1.05;95%CI:0.94,1.17;P=0.42;I2=33%),A-ARI和A-BUP之间MADRS(WMD:-2.07;95%CI:-5.84,1.70;P=0.28;I2=70%)的改善。在三种治疗策略中，不良事件和严重不良事件没有观察到显着差异。
结论：对于TRD或MDD患者，A-ARI可能是比A-BUP或S-BUP更好的综合抗抑郁治疗策略。更大规模，多中心,需要双盲RCT来进一步评估阿立哌唑或安非他酮增强和转换治疗策略的有效性和安全性.
