未经授权:急性躁狂症是一种需要快速处理的精神急症。然而,随机对照试验(RCT)显示,抗躁狂药物对躁狂症状的治疗效果存在显著的个体差异.
未经授权:我们搜索了MEDLINE,中部,EMBASE,PsycINFO,和ClinicalTrials.gov识别从开始到2022年4月19日没有语言限制的RCT。我们纳入了成人患者口服抗躁狂单药与安慰剂的双盲随机对照试验。主要结果是躁狂症状改善的变异性(使用变异系数比[CVR]评估)。次要结果是躁狂症状的总体改善和可接受性(即,因任何原因停止)。结果的合并效应是通过使用限制性最大似然方法的随机效应荟萃分析计算的。使用Cochrane偏差风险(ROB)评估工具评估纳入研究的质量。本研究注册于OSF(DOI:10.17605/OSF。IO/G4JNY)。
未经评估:我们包括39项随机对照试验(N=12150;平均年龄=39·9岁,四分位距[IQR]=38·7-41·1;女性的平均比例=48·6%,IQR=42·3%-52·3%),并研究了14种抗躁狂药物。我们发现,与安慰剂相比,八种抗躁狂药物与较低的CVRs(95%置信区间[CI];I2)相关,包括利培酮(0·51;0·37-0·70;0%),氟哌啶醇(0·54;0·44-0·67;4%),奥氮平(0·59;0·44-0·79;47%),齐拉西酮(0·61;0·53-0·71;0%),锂(0·63;0·52-0·76;0%),喹硫平(0·65;0·48-0·87;2%),阿立哌唑(0·68;0·56-0·84;25%),卡利拉嗪(0·70;0·49-0·99;28%)。有九种抗躁狂药物比安慰剂有更高的疗效,包括利培酮(报告为标准化平均差;95%CI;I2:0·64;0·31-0·97;15%),氟哌啶醇(0·57;0·29-0·85;64%),卡利拉嗪(0·51;0·24-0·78;0%),奥氮平(0·44;0·30-0·58;0%),锂(0·42;0·29-0·55;0%),齐拉西酮(0·42;0·26-0·58;0%),喹硫平(0·40;0·13-0·67;0%),阿塞那平(0·40;0·13-0·67;0%),阿立哌唑(0·32;0·14-0·49;53%)。相对于安慰剂,齐拉西酮(报告为风险比;95%CI;I2:0·83;0·79-0·89;0%)和奥氮平(0·63;0·49-0·80;35%)与更好的可接受性相关。在39个RCT中,没有人有高ROB。
UNASSIGNED:我们证明了八种抗躁狂药与安慰剂相比具有更低的变异性和更好的疗效,这表明这些抗躁狂药物与急性躁狂患者躁狂症状的改善更为均匀和可预测。
UNASSIGNED:该研究得到了科学技术部的支持(MOST-110-2314-B-016-035,MOST-111-2314-B-016-054),医务局(MND-MAB-D-111102),和三军总医院(TSGH-E-111229)。
UNASSIGNED: Acute mania is a psychiatric emergency requiring rapid management. However, randomised controlled trials (RCTs) have shown considerable individual differences in treatment effects on manic symptoms with antimanic drugs.
UNASSIGNED: We searched the MEDLINE, CENTRAL, EMBASE, PsycINFO, and ClinicalTrials.gov to identify RCTs without language restrictions from inception to April 19, 2022. We included double-blind RCTs of oral antimanic monotherapy versus placebo in adult patients. The primary outcome was variability in improvement of manic symptoms (assessed using the coefficient of variation ratio [CVR]). The secondary outcomes were overall improvement of manic symptoms and acceptability (i.e., discontinuation for any reason). The pooled effects of outcomes were calculated by random-effects meta-analyses using restricted maximum likelihood methods. The quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) Assessment Tool. This study was registered with OSF (DOI:10.17605/OSF.IO/G4JNY).
UNASSIGNED: We included 39 RCTs (N=12150; mean age=39·9 years, interquartile range [IQR]=38·7-41·1; mean proportion of female=48·6%, IQR=42·3%-52·3%) and investigated 14 antimanic drugs. We found that eight antimanic drugs compared to placebo were associated with lower CVRs (95% confidence interval [CI]; I2), including risperidone (0·51; 0·37-0·70; 0%), haloperidol (0·54; 0·44-0·67; 4%), olanzapine (0·59; 0·44-0·79; 47%), ziprasidone (0·61; 0·53-0·71; 0%), lithium (0·63; 0·52-0·76; 0%), quetiapine (0·65; 0·48-0·87; 2%), aripiprazole (0·68; 0·56-0·84; 25%), and cariprazine (0·70; 0·49-0·99; 28%). There were nine antimanic drugs associated with greater efficacy than placebo, including risperidone (reported as standardised mean difference; 95% CI; I2: 0·64; 0·31-0·97; 15%), haloperidol (0·57; 0·29-0·85; 64%), cariprazine (0·51; 0·24-0·78; 0%), olanzapine (0·44; 0·30-0·58; 0%), lithium (0·42; 0·29-0·55; 0%), ziprasidone (0·42; 0·26-0·58; 0%), quetiapine (0·40; 0·13-0·67; 0%), asenapine (0·40; 0·13-0·67; 0%), and aripiprazole (0·32; 0·14-0·49; 53%). Ziprasidone (reported as risk ratio; 95% CI; I2: 0·83; 0·79-0·89; 0%) and olanzapine (0·63; 0·49-0·80; 35%) were associated with better acceptability relative to placebo. Among the 39 RCTs, none had a high ROB.
UNASSIGNED: We demonstrated that eight antimanic drugs were associated with lower variability and better efficacy than placebo, suggesting that these antimanic drugs were associated with more homogenous and predictable improvements of manic symptoms in patients with acute mania.
UNASSIGNED: The study was supported by from the Ministry of Science and Technology (MOST-110-2314-B-016-035, MOST-111-2314-B-016-054), Medical Affairs Bureau (MND-MAB-D-111102), and Tri-service General Hospital (TSGH-E-111229).