度洛西汀與帕羅西汀治療成人抑郁癥臨床療效及安全性的Meta分析_《中國循證醫學雜志》

作者：

陳程 ¹ ,  徐維平 ¹ , 黃鶯 ¹ , 徐婷娟 ¹ , 魏偉 ² , 胡世蓮 ¹ , 嚴光 ¹

1. 安徽醫科大學附屬安徽省立醫院（合肥 230001）；2.安徽醫科大學臨床藥理研究所（合肥 230002）;

關鍵詞：

度洛西汀帕羅西汀抑郁癥 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20120052

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目的　系統評價度洛西汀與帕羅西汀比較治療成人抑郁癥的療效及不良反應。
方法　計算機檢索Cochrane Library（2011年第6期）、PubMed（1998～2011.6）、CNKI（1998～2011.6）、VIP（1998～2011.6）、CBM（1998～2011.6）、萬方數據庫（1998～2011.6）、MEDLINE（1996～2011.6）、Science Direct（1998～2010.6），納入度洛西汀與帕羅西汀比較治療成人抑郁癥的隨機對照試驗（RCT），按照Cochrane Handbook 5.0的質量評價標準評價納入研究的質量后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入6個RCT，合計1 106例抑郁癥患者。Meta分析結果顯示：① 治療8周后度洛西汀組與帕羅西汀組的有效率差異無統計學意義［RR=0.96，95%CI（0.89，1.05），P=0.39］，其最終治愈率差異亦無統計學意義［RR=0.99，95%CI（0.86，1.15），P=0.93］。② 不良反應：度洛西汀組嗜睡的發生率低于帕羅西汀組［RR=0.63 95%CI（0.41，0.96），P=0.03］，而心電圖異常發生率高于帕羅西汀組［RR=1.91 95%CI（1.02，3.58），P=0.04］，其余常見的不良反應兩組差異無統計學意義（P gt;0.05）。
結論　度洛西汀在8周療程結束時有效率及最終治愈率與帕羅西汀差異無統計學差異；在常見不良反應中，度洛西汀較帕羅西汀更易引起心電圖異常。

引用本文： 陳程,徐維平,黃鶯,徐婷娟,魏偉,胡世蓮,嚴光. 度洛西汀與帕羅西汀治療成人抑郁癥臨床療效及安全性的Meta分析. 中國循證醫學雜志, 2012, 12(3): 320-325. doi: 10.7507/1672-2531.20120052 復制

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7.	Maier W, Philipp M. Improving the assessment of severity of depressive states: a reduction of the Hamilton Depression Scale. Pharmacopsychiatry, 1985, 18: 114-115.
8.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
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11.	Lee P, Shu L, Xu X, et al. Once-daily duloxetine 60 mg in the treatment of major depressive disorder: multicenter, double-blind, randomized, paroxetine-controlled, non-inferiority trial in China, Korea, Taiwan and Brazil. Psychiatry Clin Neurosci, 2007, 61(3): 295-307.
12.	邱堂威, 彭德華, 劉敏. 度洛西汀與帕羅西汀治療抑郁癥對照分析. 中國民康醫學, 2008, 20(23): 2772-2774.
13.	李雪漢. 鹽酸度洛西汀治療抑郁癥的臨床療效和安全性. 河北醫科大學學報, 2011, 32(2): 199-201.
14.	張雄, 馬世發, 李亞軍. 度洛西汀與帕羅西汀治療抑郁癥對照觀察. 中外醫學研究, 2011, 9(1): 16-17.
15.	Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al. Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology, 2001, 25(6): 871-880.
16.	Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs, 2009, 23(6): 523-541.
17.	Wohlreich MM, Mallinckrodt CH, Prakash A, et al. Duloxetine for the treatment of major depressive disorder: safety and tolerability associated with dose escalation. Depress Anxiety, 2007, 24(1): 41-52.
18.	Trivedi MH, Desaiah D, Ossanna MJ, et al. Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. Int Clin Psychopharmacol, 2008, 23(3): 161-169.
19.	Schueler YB, Koesters M, Wieseler B, et al. A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatr Scand, 2011, 123(4): 247-265.
20.	Skljarevski V, Zhang S, Desaiah D, et al. Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed-dose, randomized, double-blind trial. J Pain, 2010, 11(12): 1282-1290.
21.	Fishbain DA, Hall J, Meyers AL, et al. Does pain mediate the pain interference with sleep problem in chronic pain? Findings from studies for management of diabetic peripheral neuropathic pain with duloxetine. J Pain Symptom Manage, 2008, 36(6): 639-647.
22.	Kluge M, Schüssler P, Steiger A, et al. Duloxetine increases stage 3 sleep and suppresses rapid eye movement (REM) sleep in patients with major depression. Eur Neuropsychopharmacol, 2007, 17(8): 527-531.
23.	Thase ME, Tran PV, Wiltse C, et al. Cardiovascular profile of duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine. J Clin Psychopharmacol, 2005, 25(2): 132-140.
24.	Gahimer J, Wernicke J, Yalcin I, et al. A retrospective pooled analysis of duloxetine safety in 23,983 subjects. Curr Med Res Opin, 2007, 23(1): 175-184.
25.	Zhang L, Chappell J, Gonzales CR, et al. QT effects of duloxetine at supratherapeutic doses: a placebo and positive controlled study. J Cardiovasc Pharmacol, 2007, 49(3): 146-153.
26.	Xue F, Strombom I, Turnbull B, et al. Treatment with duloxetine in adults and the incidence of cardiovascular events. J Clin Psychopharmacol, 2012, 32(1): 23-30.
27.	Wernicke J, Lledó A, Raskin J, et al. An evaluation of the cardiovascular safety profile of duloxetine: findings from 42 placebo-controlled studies. Drug Saf, 2007, 30(5): 437-455.

1. Greden JF. The burden of disease for treatment-resistant depression. J Clin Psychiatry, 2001, 62 Suppl 16: 26-31.
2. Perahia DG, Quail D, Desaiah D, et al. Switching to duloxetine in selective serotonin reuptake inhibitor non- and partial-responders: effects on painful physical symptoms of depression. J Psychiatr Res, 2009, 43(5): 512-518.
3. Knadler MP, Lobo E, Chappell J, et al. Duloxetine: clinical pharmacokinetics and drug interactions. Clin Pharmacokinet, 2011, 50(5): 281-294.
4. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet, 2009, 373(9665): 746-758.
5. Cremers TI, Rea K, Bosker FJ, et al. Augmentation of SSRI effects on serotonin by 5-HT2C antagonists: mechanistic studies. Neuropsychopharmacology, 2007, 32(7): 1550-1557.
6. Gueorguieva R, Mallinckrodt C, Krystal JH. Trajectories of depression severity in clinical trials of duloxetine: insights into antidepressant and placebo responses. Arch Gen Psychiatry, 2011, 68(12): 1227-1237.
7. Maier W, Philipp M. Improving the assessment of severity of depressive states: a reduction of the Hamilton Depression Scale. Pharmacopsychiatry, 1985, 18: 114-115.
8. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
9. Detke MJ, Wiltse CG, Mallinckrodt CH, et al. Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Neuropsychopharmacol, 2004, 14(6): 457-470.
10. Perahia DG, Wang F, Mallinckrodt CH, et al. Duloxetine in the treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Psychiatry, 2006, 21(6): 367-378.
11. Lee P, Shu L, Xu X, et al. Once-daily duloxetine 60 mg in the treatment of major depressive disorder: multicenter, double-blind, randomized, paroxetine-controlled, non-inferiority trial in China, Korea, Taiwan and Brazil. Psychiatry Clin Neurosci, 2007, 61(3): 295-307.
12. 邱堂威, 彭德華, 劉敏. 度洛西汀與帕羅西汀治療抑郁癥對照分析. 中國民康醫學, 2008, 20(23): 2772-2774.
13. 李雪漢. 鹽酸度洛西汀治療抑郁癥的臨床療效和安全性. 河北醫科大學學報, 2011, 32(2): 199-201.
14. 張雄, 馬世發, 李亞軍. 度洛西汀與帕羅西汀治療抑郁癥對照觀察. 中外醫學研究, 2011, 9(1): 16-17.
15. Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al. Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors. Neuropsychopharmacology, 2001, 25(6): 871-880.
16. Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs, 2009, 23(6): 523-541.
17. Wohlreich MM, Mallinckrodt CH, Prakash A, et al. Duloxetine for the treatment of major depressive disorder: safety and tolerability associated with dose escalation. Depress Anxiety, 2007, 24(1): 41-52.
18. Trivedi MH, Desaiah D, Ossanna MJ, et al. Clinical evidence for serotonin and norepinephrine reuptake inhibition of duloxetine. Int Clin Psychopharmacol, 2008, 23(3): 161-169.
19. Schueler YB, Koesters M, Wieseler B, et al. A systematic review of duloxetine and venlafaxine in major depression, including unpublished data. Acta Psychiatr Scand, 2011, 123(4): 247-265.
20. Skljarevski V, Zhang S, Desaiah D, et al. Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed-dose, randomized, double-blind trial. J Pain, 2010, 11(12): 1282-1290.
21. Fishbain DA, Hall J, Meyers AL, et al. Does pain mediate the pain interference with sleep problem in chronic pain? Findings from studies for management of diabetic peripheral neuropathic pain with duloxetine. J Pain Symptom Manage, 2008, 36(6): 639-647.
22. Kluge M, Schüssler P, Steiger A, et al. Duloxetine increases stage 3 sleep and suppresses rapid eye movement (REM) sleep in patients with major depression. Eur Neuropsychopharmacol, 2007, 17(8): 527-531.
23. Thase ME, Tran PV, Wiltse C, et al. Cardiovascular profile of duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine. J Clin Psychopharmacol, 2005, 25(2): 132-140.
24. Gahimer J, Wernicke J, Yalcin I, et al. A retrospective pooled analysis of duloxetine safety in 23,983 subjects. Curr Med Res Opin, 2007, 23(1): 175-184.
25. Zhang L, Chappell J, Gonzales CR, et al. QT effects of duloxetine at supratherapeutic doses: a placebo and positive controlled study. J Cardiovasc Pharmacol, 2007, 49(3): 146-153.
26. Xue F, Strombom I, Turnbull B, et al. Treatment with duloxetine in adults and the incidence of cardiovascular events. J Clin Psychopharmacol, 2012, 32(1): 23-30.
27. Wernicke J, Lledó A, Raskin J, et al. An evaluation of the cardiovascular safety profile of duloxetine: findings from 42 placebo-controlled studies. Drug Saf, 2007, 30(5): 437-455.

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度洛西汀與帕羅西汀治療成人抑郁癥臨床療效及安全性的Meta分析

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《中國循證醫學雜志》

度洛西汀與帕羅西汀治療成人抑郁癥臨床療效及安全性的Meta分析

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