背景:许多文章表明,氯氮平与新发糖尿病的高发病率密切相关,这个问题仍然没有解决。许多文章将氯氮平与FGA进行了比较,但很少有人将氯氮平与SGAs进行比较。我们旨在比较使用氯氮平和其他SGA治疗的成年精神分裂症患者新发糖尿病的风险。
方法:我们从数据库开始到2023年8月26日对数据库进行了全面搜索。具体的数据库包括PubMed、Embase和其他人。我们纳入了涉及使用SGAs如氯氮平的非随机对照试验,奥氮平,利培酮,喹硫平,氨磺必利,和zotepine,重点关注新发糖尿病的结局。我们使用95%可信区间(95%CI)的比值比作为我们的效应大小度量。研究方案在PROSPERO注册,编号CRD42024511280。
结果:我们纳入了7项研究,这些研究的数据足以纳入荟萃分析。共有8项研究,641,48名参与者符合资格标准。氯氮平和奥氮平新发糖尿病发病率的OR为0.95(95%CI:[0.82-1.09]),氯氮平和利培酮之间为1.25(95%CI:[1.09-1.44]),氯氮平和喹硫平之间为1.44(95%CI:[0.92-2.25]).
结论:在精神分裂症患者中,与利培酮相比,发现氯氮平的新发糖尿病发生率更高。然而,氯氮平与奥氮平和喹硫平的发病率无显著差异.这些发现可以帮助临床医生平衡这些药物的风险和益处。
BACKGROUND: Many articles suggest that clozapine was strongly associated with a higher incidence of new-onset diabetes mellitus, and the issue has remained unsettled. Many articles have compared clozapine with FGAs, but few have compared clozapine with SGAs. We aimed to compare the risk of new-onset diabetes mellitus in adults with schizophrenia treated with clozapine and other SGAs.
METHODS: We conducted a comprehensive search of databases from their inception up until August 26, 2023. The specific databases include PubMed, Embase and others. We included non-randomized controlled trials involving the use of SGAs such as clozapine, olanzapine,
risperidone, quetiapine, amisulpride, and zotepine, with a focus on new-onset diabetes mellitus as an outcome. We utilized odds ratio with 95 % credible intervals (95 % CI) as our effect size measures. The study protocol is registered with PROSPERO, number CRD42024511280.
RESULTS: We included 7 studies with sufficient data to include in the meta-analysis. A total of eight studies with 641,48 participants met the eligibility criteria. The OR of the incidence rates of new-onset diabetes between clozapine and olanzapine was 0.95 (95 % CI:[0.82-1.09]), between clozapine and
risperidone was 1.25 (95 % CI: [1.09-1.44]), between clozapine and quetiapine was 1.44 (95 % CI: [0.92-2.25]).
CONCLUSIONS: In patients with schizophrenia, clozapine has been found to have a higher rate of new-onset diabetes mellitus compared to
risperidone. However, there was no significant difference in incidence rate between clozapine versus olanzapine and quetiapine. These findings can assist clinicians in balancing the risks and benefits of those drugs.