■抗精神病药诱导的静坐不能(AIA)发生在14%至35%的抗精神病药治疗的患者中,并且与精神分裂症患者的自杀增加和依从性下降有关。然而,没有进行全面综述和网络荟萃分析来比较AIA治疗的疗效.
■比较与AIA治疗相关的疗效。
■三个数据库(MEDLINE,WebofScience,和GoogleScholar)由多名研究人员系统地搜索,以进行双盲随机临床试验(RCT),比较2023年5月30日至6月18日之间用于治疗AIA的活性药物与安慰剂或另一种治疗。
选定的研究是RCT,比较了AIA的辅助药物与安慰剂或辅助治疗的患者的抗精神病药物治疗符合静坐不能标准,样本量为10例或以上的RCT,只有在研究期间没有额外药物的试验,和使用经过验证的静坐不能评分的随机对照试验。排除了主要结局数据缺失的试验(终点的静坐不能评分)。
■进行了数据提取和合成,通过随机效应模型的成对和网络荟萃分析估计标准化平均差(SMD)。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目。
■主要结局是在最后一个可用终点通过验证量表测量的静坐不能严重程度。
■涉及492名参与者的15项试验将10种治疗方法与安慰剂进行了比较。米氮平(15mg/d,≥5天;SMD,-1.20;95%CI,-1.83至-0.58),Biperiden(6mg/d,≥14天;SMD,-1.01;95%CI,-1.69至-0.34),维生素B6(600-1200毫克/天,≥5天;SMD,-0.92;95%CI,-1.57至-0.26),曲唑酮(50mg/d,≥5天;SMD,-0.84;95%CI,-1.54至-0.14),米安色林(15mg/d,≥5天;SMD,-0.81;95%CI,-1.44至-0.19),和普萘洛尔(20mg/d,≥6天;SMD,-0.78;95%CI,-1.35至-0.22)与比安慰剂更大的疗效相关,具有低到中度异质性(I2=34.6%;95%CI,0.0%-71.1%)。赛庚啶,氯硝西泮,佐米曲坦,和丙戊酸没有产生显著的影响。8项试验被评为低偏倚风险;2,中度风险;5,高风险。敏感性分析通常证实了除赛庚啶和普萘洛尔以外的所有药物的结果。未发现效应大小与精神病严重程度之间存在关联。
■在这篇系统综述和网络荟萃分析中,米氮平,Biperiden,和维生素B6与AIA的最大功效相关,维生素B6具有最好的功效和耐受性。曲唑酮,米安色林,和普萘洛尔似乎是有效的替代品,但疗效和耐受性略差。这些发现应有助于处方者选择治疗AIA的适当药物。
UNASSIGNED: Antipsychotic-induced akathisia (AIA) occurs in 14% to 35% of patients treated with antipsychotics and is associated with increased suicide and decreased adherence in patients with schizophrenia. However, no comprehensive review and network meta-analysis has been conducted to compare the efficacy of treatments for AIA.
UNASSIGNED: To compare the efficacy associated with AIA treatments.
UNASSIGNED: Three databases (MEDLINE, Web of Science, and Google Scholar) were systematically searched by multiple researchers for double-blind randomized clinical trials (RCTs) comparing active drugs for the treatment of AIA with placebo or another treatment between May 30 and June 18, 2023.
UNASSIGNED: Selected studies were RCTs that compared adjunctive drugs for AIA vs placebo or adjunctive treatment in patients treated with antipsychotics fulfilling the criteria for akathisia, RCTs with sample size of 10 patients or more, only trials in which no additional drugs were administered during the study, and RCTs that used a validated akathisia score. Trials with missing data for the main outcome (akathisia score at the end points) were excluded.
UNASSIGNED: Data extraction and synthesis were performed, estimating standardized mean differences (SMDs) through pairwise and network meta-analysis with a random-effects model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed.
UNASSIGNED: The primary outcome was the severity of akathisia measured by a validated scale at the last available end point.
UNASSIGNED: Fifteen trials involving 492 participants compared 10 treatments with placebo. Mirtazapine (15 mg/d for ≥5 days; SMD, -1.20; 95% CI, -1.83 to -0.58),
biperiden (6 mg/d for ≥14 days; SMD, -1.01; 95% CI, -1.69 to -0.34), vitamin B6 (600-1200 mg/d for ≥5 days; SMD, -0.92; 95% CI, -1.57 to -0.26), trazodone (50 mg/d for ≥5 days; SMD, -0.84; 95% CI, -1.54 to -0.14), mianserin (15 mg/d for ≥5 days; SMD, -0.81; 95% CI, -1.44 to -0.19), and propranolol (20 mg/d for ≥6 days; SMD, -0.78; 95% CI, -1.35 to -0.22) were associated with greater efficacy than placebo, with low to moderate heterogeneity (I2 = 34.6%; 95% CI, 0.0%-71.1%). Cyproheptadine, clonazepam, zolmitriptan, and valproate did not yield significant effects. Eight trials were rated as having low risk of bias; 2, moderate risk; and 5, high risk. Sensitivity analyses generally confirmed the results for all drugs except for cyproheptadine and propranolol. No association between effect sizes and psychotic severity was found.
UNASSIGNED: In this systematic review and network meta-analysis, mirtazapine,
biperiden, and vitamin B6 were associated with the greatest efficacy for AIA, with vitamin B6 having the best efficacy and tolerance profile. Trazodone, mianserin, and propranolol appeared as effective alternatives with slightly less favorable efficacy and tolerance profiles. These findings should assist prescribers in selecting an appropriate medication for treating AIA.