背景:治疗方案对急性双相躁狂发作疗效的证据在年轻人中相对低于成年人。我们的目的是比较和排名药物的疗效,可接受性,耐受性,以及儿童和青少年急性躁狂症的安全性。
方法:我们系统地回顾了双盲,使用PRISMA指南比较药物或安慰剂治疗儿童和青少年双相情感障碍急性躁狂发作的随机对照试验(RCT).我们搜索了PubMed/MEDLINE,EMBASE,WebofScience,EBSCO,Scopus,Cochrane中央受控试验登记册,和https://clinicaltrials.gov从成立到2022年11月20日。对治疗的反应是主要结果,并进行了随机效应网络荟萃分析(PROSPERO2022:CRD42022367455)。
结果:在10,134次引用中,我们纳入了15项随机对照试验,包括2372名患者(47%为女性),15种精神药物,和安慰剂。利培酮0.5-2.5毫克/天,阿立哌唑30毫克/天奥氮平,喹硫平400毫克/天,喹硫平600毫克/天,阿塞那平5毫克/天,阿塞那平10毫克,齐拉西酮,和阿立哌唑10毫克被发现是有效的(与安慰剂相比)在儿童和青少年,分别为(τ2=0.0072,I2=10.2%)。阿立哌唑30mg/天的耐受性低于利培酮0.5-2.5mg/天和奥氮平。由于不良反应的风险比,奥卡西平的停药率最高。
结论:可以通过评估相对较少的RCT结果来进行治疗的疗效排序,只考虑单一疗法。
结论:疗效,可接受性,耐受性,随着儿童和青少年急性双相躁狂发作的抗精神病药物剂量的增加,安全性也在变化。儿童和青少年应仔细调整药物选择和最佳剂量。
BACKGROUND: The evidence of treatment options\' efficacy on acute bipolar manic episodes is relatively less in youths than adults. We aimed to compare and rank the drug\'s efficacy, acceptability, tolerability, and safety for acute
mania in children and adolescents.
METHODS: We systematically reviewed the double-blinded, randomized controlled trials (RCTs) comparing drugs or placebo for acute manic episodes of bipolar disorder in children and adolescents using PRISMA guidelines. We searched PubMed/MEDLINE, EMBASE, Web of Science, EBSCO, Scopus, the Cochrane Central Register of Controlled Trials, and https://clinicaltrials.gov from inception until November 20, 2022. Response to treatment was the primary outcome, and random-effects network meta-analyses were conducted (PROSPERO 2022: CRD42022367455).
RESULTS: Of 10,134 citations, we included 15 RCTs, including 2372 patients (47 % female), 15 psychotropic drugs, and the placebo. Risperidone 0.5-2.5 mg/day, aripiprazole 30 mg/day olanzapine, quetiapine 400 mg/day, quetiapine 600 mg/day, asenapine 5 mg/day, asenapine 10 mg, ziprasidone, and aripiprazole 10 mg were found to be effective (in comparison with placebo) in children and adolescents, respectively (τ2 = 0.0072, I2 = 10.2 %). The tolerability of aripiprazole 30 mg/day was lower than risperidone 0.5-2.5 mg/day and olanzapine. Oxcarbazepine had the highest discontinuation due to the adverse effects risk ratio.
CONCLUSIONS: Efficacy ranking of the treatments could be performed by evaluating relatively few RCT results, and only monotherapies were considered.
CONCLUSIONS: Efficacy, acceptability, tolerability, and safety are changing with the doses of antipsychotics for children and adolescents with acute bipolar manic episodes. Drug selection and optimum dosage should be carefully adjusted in children and adolescents.