艾司西酞普兰治疗儿童和青少年抑郁症的Meta分析
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摘要
目的系统评价艾司西酞普兰治疗儿童和青少年抑郁症的疗效与安全性。方法计算机检索PubMed、 Embase、 Cochrane图书馆、中国知网、维普全文数据库、中国生物医学文献数据库和万方数据库中关于艾司西酞普兰治疗儿童和青少年抑郁症疗效与安全性的随机对照试验(RCT),采用Cochrane协作网推荐的RevMan 5.3软件对各效应指标进行Meta分析。结果共纳入3项RCT,合计888例儿童和青少年患者。Meta分析结果显示:艾司西酞普兰组有效率显著高于安慰剂组(OR=1.61, 95%CI:1.23～2.11, P=0.000 5),但患者耐受性显著低于安慰剂组(OR=3.62, 95%CI:1.18～11.05, P=0.02);在安全性方面, 2组患者不良反应发生率差异无显著意义(OR=1.14, 95%CI:0.84～1.55, P=0.41),患者自我伤害行为或想法发生率差异亦无显著意义(OR=1.08, 95%CI:0.55～2.13, P=0.83)。结论艾司西酞普兰治疗儿童、青少年抑郁症的疗效优于安慰剂,其不良反应和自我伤害发生率与安慰剂相当。
AIM To systematically evaluate the efficacy and safety of escitalopram in the treatment of children and adolescents with depression. METHODS Randomized controlled trials(RCTs) of escitalopram in the treatment of depression in children and adolescents were searched in PubMed, Embase, Cochrane Library,CNKI, VIP, CBM and Wangfang database by computer. The meta-analysis was carried out by using RevMan5.3 software. RESULTS A total of 3 RCTs involving 888 patients were included for the final analysis. The response rate was higher in the escitalopram group than that of the placebo group(OR = 1.61, 95% CI: 1.23-2.11, P = 0.000 5), but the patient tolerance was significantly lower in the escitalopram group than that of the placebo group(OR = 3.62, 95%CI: 1.18-11.05, P = 0.02). There was no significant difference in the rate of adverse reactions( OR = 1.14, 95%CI: 0.84-1.55, P = 0.41) and the incidence of self-harm behaviors or thoughts(OR = 1.08, 95%CI: 0.55-2.13, P = 0.83) between the two groups. CONCLUSION Escitalopram is more effective than placebo in treating children and adolescents with depression, and there was no significant difference in rates of adverse reactions and self-harm.
AIM To systematically evaluate the efficacy and safety of escitalopram in the treatment of children and adolescents with depression. METHODS Randomized controlled trials(RCTs) of escitalopram in the treatment of depression in children and adolescents were searched in PubMed, Embase, Cochrane Library,CNKI, VIP, CBM and Wangfang database by computer. The meta-analysis was carried out by using RevMan5.3 software. RESULTS A total of 3 RCTs involving 888 patients were included for the final analysis. The response rate was higher in the escitalopram group than that of the placebo group(OR = 1.61, 95% CI: 1.23-2.11, P = 0.000 5), but the patient tolerance was significantly lower in the escitalopram group than that of the placebo group(OR = 3.62, 95%CI: 1.18-11.05, P = 0.02). There was no significant difference in the rate of adverse reactions( OR = 1.14, 95%CI: 0.84-1.55, P = 0.41) and the incidence of self-harm behaviors or thoughts(OR = 1.08, 95%CI: 0.55-2.13, P = 0.83) between the two groups. CONCLUSION Escitalopram is more effective than placebo in treating children and adolescents with depression, and there was no significant difference in rates of adverse reactions and self-harm.
引文
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[2]陶然,纪文博,张惠敏.青少年抑郁症研究新进展[J].武警医学,2015,26(2):109-112.
[3]李玖玲,陈星,赵春华,等.中国儿童青少年抑郁症状流行率的Meta分析[J].中国儿童保健杂志,2016,24(3):295-298.
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[6]TAURINES R,GERLACH M,WARNKE A,et al.Pharmacotherapy in depressed children and adolescents[J].World J Biol Psychiatry,2011,12 Suppl 1:11-15.
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[13]WAGNER KD,JONAS J,FINDLING RL,et al.A doubleblind,randomized,placebo-controlled trial of escitalopram in the treatment of pediatric depression[J].J Am Acad Child Adolesc Psychiatry,2006,45(3):280‐288.
[14]EMSLIE GJ,VENTURA D,KOROTZER A,et al.Escitalopram in the treatment of adolescent depression:a randomized placebocontrolled multisite trial[J].J Am Acad Child Adolesc Psychiatry,2009,48(7):721-729.
[15]FINDLING RL,ROBB A,BOSE A.Escitalopram in the treatment of adolescent depression:a randomized,doubleblind,placebo-controlled extension trial[J].J Child Adolesc Psychopharmacol,2013,23(7):468-480.
[16]张亚同,傅得兴.艾司西酞普兰的药理及临床评价[J].中国新药杂志,2006,15(22):1979-1983.
[17]SCHALLER JL,RAWLINGS DB.Escitalopram in adolescent major depression[J].MedGenMed,2005,7(1):6.
[18]CHEUNG AH,ZUCKERBROT RA,JENSEN PS,et al.Guidelines for adolescent depression in primary care(GLAD-PC):partⅡ.Treatment and ongoing management[J].Pediatrics,2018.doi:10.1542/peds.2017-4082.
[19]王文茜,伍三兰,陈晨.艾司西酞普兰不良反应文献分析[J].医药导报,2018,37(2):256-260.
[20]CHEE KY,TRIPATHI A,AVASTHI A,et al.Prescribing pattern of antidepressants in children and adolescents:findings from the research on Asia psychotropic prescription pattern[J].East Asian Arch Psychiatry,2016,26(1):10-17.
[21]IGNASZEWSKI MJ,WASLICK B.Update on randomized placebo-controlled trials in the past decade for treatment of major depressive disorder in child and adolescent patients:a systematic review[J].J Child Adolesc Psychopharmacol,2018.doi.org/10.1089/cap.2017.0174.
[22]CIPRIANI A,ZHOU X,DEL GIOVANE C,et al.Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents:a network meta-analysis[J].Lancet,2016,388(10047):881-890.
[23]MA D,ZHANG Z,ZHANG X,et al.Comparative efficacy,acceptability,and safety of medicinal,cognitive-behavioral therapy,and placebo treatments for acute major depressive disorder in children and adolescents:a multiple-treatments meta-analysis[J].Curr Med Res Opin,2014,30(6):971-995.
[2]陶然,纪文博,张惠敏.青少年抑郁症研究新进展[J].武警医学,2015,26(2):109-112.
[3]李玖玲,陈星,赵春华,等.中国儿童青少年抑郁症状流行率的Meta分析[J].中国儿童保健杂志,2016,24(3):295-298.
[4]VOGEL W.Depression in children and adolescents[J].CME:Your SA J CPD,2012,30(4):114-117.
[5]闫俊娟,崔永华.近5年儿童青少年精神科住院患者抗抑郁药临床使用情况分析[J].临床精神医学杂志,2016,26(6):388-390.
[6]TAURINES R,GERLACH M,WARNKE A,et al.Pharmacotherapy in depressed children and adolescents[J].World J Biol Psychiatry,2011,12 Suppl 1:11-15.
[7]农开磊,潘南方,刘方钰,等.儿童抑郁症的药物治疗研究进展[J].四川生理科学杂志,2018,40(2):141-146.
[8]张喜燕,杜亚松.儿童青少年抑郁症的药物治疗[J].世界临床药物,2013,34(6):380-384.
[9]FDA.Suicidality in children and adolescents being treated with antidepressant medications[EB/OL].(2014-10-15)[2018-11-28].https://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsand-providers/ucm161679.htm.
[10]FDA.FDA drug safety communication:revised recommendations for celexa(citalopram hydrobromide)related to a potential risk of abnormal heart rhythms with high doses[EB/OL].(2012-03-28)[2018-11-28].https://www.fda.gov/Drugs/DrugSafety/ucm297391.htm.
[11]苑杰,严辞,李永秋,等.抗抑郁药物长期治疗的潜在风险性[J].中国新药与临床杂志,2016,35(7):464-468.
[12]JUNI P,ALTMAN DG,EGGER M.Systematic reviews in health care:assessing the quality of controlled clinical trials[J].BMJ,2001,323(7303):42-46.
[13]WAGNER KD,JONAS J,FINDLING RL,et al.A doubleblind,randomized,placebo-controlled trial of escitalopram in the treatment of pediatric depression[J].J Am Acad Child Adolesc Psychiatry,2006,45(3):280‐288.
[14]EMSLIE GJ,VENTURA D,KOROTZER A,et al.Escitalopram in the treatment of adolescent depression:a randomized placebocontrolled multisite trial[J].J Am Acad Child Adolesc Psychiatry,2009,48(7):721-729.
[15]FINDLING RL,ROBB A,BOSE A.Escitalopram in the treatment of adolescent depression:a randomized,doubleblind,placebo-controlled extension trial[J].J Child Adolesc Psychopharmacol,2013,23(7):468-480.
[16]张亚同,傅得兴.艾司西酞普兰的药理及临床评价[J].中国新药杂志,2006,15(22):1979-1983.
[17]SCHALLER JL,RAWLINGS DB.Escitalopram in adolescent major depression[J].MedGenMed,2005,7(1):6.
[18]CHEUNG AH,ZUCKERBROT RA,JENSEN PS,et al.Guidelines for adolescent depression in primary care(GLAD-PC):partⅡ.Treatment and ongoing management[J].Pediatrics,2018.doi:10.1542/peds.2017-4082.
[19]王文茜,伍三兰,陈晨.艾司西酞普兰不良反应文献分析[J].医药导报,2018,37(2):256-260.
[20]CHEE KY,TRIPATHI A,AVASTHI A,et al.Prescribing pattern of antidepressants in children and adolescents:findings from the research on Asia psychotropic prescription pattern[J].East Asian Arch Psychiatry,2016,26(1):10-17.
[21]IGNASZEWSKI MJ,WASLICK B.Update on randomized placebo-controlled trials in the past decade for treatment of major depressive disorder in child and adolescent patients:a systematic review[J].J Child Adolesc Psychopharmacol,2018.doi.org/10.1089/cap.2017.0174.
[22]CIPRIANI A,ZHOU X,DEL GIOVANE C,et al.Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents:a network meta-analysis[J].Lancet,2016,388(10047):881-890.
[23]MA D,ZHANG Z,ZHANG X,et al.Comparative efficacy,acceptability,and safety of medicinal,cognitive-behavioral therapy,and placebo treatments for acute major depressive disorder in children and adolescents:a multiple-treatments meta-analysis[J].Curr Med Res Opin,2014,30(6):971-995.