Efficacy of pharmacological agents for the management of treatment-resistant schizophrenia: a network meta-analysis.

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY Expert Review of Clinical Pharmacology Pub Date : 2024-03-01 Epub Date: 2024-01-26 DOI:10.1080/17512433.2024.2310715

Archana Mishra, Rituparna Maiti, Biswa Ranjan Mishra, Anand Srinivasan

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Abstract

Objective: The present network meta-analysis (NMA) was conducted to compare and generate evidence for the most efficacious treatment among available pharmacological interventions for treatment-resistant schizophrenia (TRS).

Methods: Reviewers extracted data from 47 studies screened from PubMed/MEDLINE, Embase, Cochrane databases and clinical trial registries fulfilling the eligibility criteria. Random effects Bayesian NMA was done with non-informative priors. Network geometry was visualized, and node splitting was done for the closed triangles. Standardized mean difference and 95% credible interval(95%CrI) were reported for the reduction in symptom severity scores. The probability of each intervention for each rank was plotted. Meta-regression was done for the duration of the therapy.

Results: Augmentation of antipsychotics with escitalopram (SMD: -1.7[95%CrI: -2.8, -0.70]), glycine (SMD: -1.2 [95%CrI: -2.2, -0.28]) and Yokukansan (SMD: -1.3 [95%CrI: -2.4, -0.24]) shows a statistically significant reduction in symptom severity when compared to clozapine. As per surface under cumulative ranking curve analysis, escitalopram in combination with antipsychotics appeared to be the best intervention with moderate certainty of evidence. There was no significant effect of the duration of therapy on the treatment effects.

Conclusion: Escitalopram augmentation of antipsychotics appears to be the most efficacious treatment with moderate certainty of evidence among the available pharmacological interventions.

Prospero registration: CRD42022380292.

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治疗耐药性精神分裂症的药理药剂治疗耐药性精神分裂症的药理药剂治疗耐药性精神分裂症的药理药剂治疗耐药性精神分裂症的药理药剂治疗耐药性精神分裂症的药理药剂的疗效：网络荟萃分析。

研究目的本网络荟萃分析（NMA）旨在比较现有药物干预治疗难治性精神分裂症（TRS）的疗效，并提供最有效治疗的证据：研究人员从符合资格标准的 47 项研究中提取数据，这些研究来自 PubMed/MEDLINE、Embase、Cochrane 数据库和临床试验登记处。随机效应贝叶斯 NMA 采用非信息先验进行。对网络几何形状进行了可视化处理，并对封闭三角形进行了节点分割。报告了症状严重程度评分减少的标准化平均差和 95% 可信区间（95%CrI）。绘制了每种干预措施对每个等级的作用概率。对治疗持续时间进行了元回归：结果：与氯氮平相比，使用艾司西酞普兰（SMD：-1.7[95%CrI：-2.8, -0.70]）、甘氨酸（SMD：-1.2[95%CrI：-2.2, -0.28]）和Yokukansan（SMD：-1.3[95%CrI：-2.4, -0.24]）增强抗精神病药物可显著降低症状严重程度。根据累积排名曲线的表面分析，艾司西酞普兰与抗精神病药物联用似乎是最佳的干预措施，证据的确定性为中等。治疗持续时间对治疗效果没有明显影响：结论：在现有的药物干预中，艾司西酞普兰联合抗精神病药物似乎是最有效的治疗方法，其证据具有中等确定性：CRD42022380292。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.30

自引率

2.30%

发文量

127

期刊介绍： Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.