精神分裂症新试验的证据与现有证据在哪里相符:皇帝新衣的案例?

IF 3.6 Q1 PSYCHIATRY Schizophrenia Research and Treatment Pub Date : 2012-01-01 Epub Date: 2012-04-08 DOI:10.1155/2012/625738
Mahesh Jayaram, Ranganath D Rattehalli, Clive E Adams
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引用次数: 2

摘要

近年来,“非典型”抗精神病药物的出现催生了新的试验,此类试验报告的数量呈指数级增长。作为临床医生,我们一直被引导相信“非典型”比“典型”好,尽管在学术和临床圈子里有奇怪的反对声音。这在很大程度上被忽视了,直到两项具有里程碑意义的、独立的、实用的试验——精神分裂症研究中最新抗精神病药物的干预有效性临床抗精神病药物试验(CATIE)和成本效用(CUtLASS)的发表,证明了精心选择的“典型”抗精神病药物与较新的“非典型”抗精神病药物一样好。我们汇集了在CATIE和CUtLASS之前存在的Cochrane综述中的“早期离开研究数据”,并将CATIE和CUtLASS的数据加入到“前后”比较池中。CATIE和CUtLASS数据的增加只导致已经存在的置信区间的缩小,仅仅增加了精度,并降低了II型错误的风险。也许令人惊讶的是,当CATIE和CUtLASS与已经存在的数据结合在一起时,我们发现我们选择了对已经存在的发现视而不见。这让临床医生提出了一个问题:在未来,我们是否需要对过早地大喊“皇帝没穿衣服”感到不那么内疚?
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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Where Does Evidence from New Trials for Schizophrenia Fit with the Existing Evidence: A Case of the Emperor's New Clothes?

Advent of "atypical" antipsychotics has spawned new trials in the recent years and the number of such trial reports has been increasing exponentially. As clinicians we have been led to believe that "atypicals" are better than "typicals" despite the odd dissenting voice in academic and clinical circles. This has been largely ignored until the publication of two landmark, independent, pragmatic trials, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), which proved that thoughtfully chosen "typical" antipsychotics were as good as the newer "atypicals." We pooled "leaving the study early data" from Cochrane Reviews that existed before CATIE and CUtLASS and added data from CATIE and CUtLASS to the pool for a "before and after" comparison. Addition of CATIE and CUtLASS data only led to narrowing of the already existing confidence intervals, merely increasing precision, and decreasing the risk of Type II error. Perhaps surprisingly, CATIE and CUtLASS when pooled with the already existing data showed us that we had chosen to turn a blind eye to findings that already existed. This leads clinicians to question as to whether, in future, we need to feel less guilty about crying out early on that the emperor has no clothes on.

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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
2
审稿时长
14 weeks
期刊介绍: Schizophrenia Research and Treatment is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to all aspects of schizophrenia.
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