帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性的meta分析

Efficacy and Safety of Paroxetine and Other Selective 5-HT Reuptake Inhibitors: A Meta-analysis

关键词:  帕罗西汀  抗抑郁  选择性5-HT再摄取抑制药  meta分析

Key words:  paroxetine  antidepressant  selective 5-HT reuptake inhibitor  meta-analysis

摘要:

目的 评价帕罗西汀与其他选择性5-HT再摄取抑制药的疗效及安全性。方法 计算机检索Cochrane图书馆、ISI数据库、中国知网（CNKI）、维普（VIP）、万方数字化期刊数据库，纳入帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性随机对照试验（randomized controlled trial，RCT）、系统评价和meta分析文献，对纳入文献的RCTs进行方法学质量评价和meta分析，参考纳入文献的系统评价和meta分析结论。结果 帕罗西汀与其他选择性5-HT再摄取抑制药疗效及安全性对比分析共纳入15个RCTs。2组抗抑郁总有效率差异有统计学意义（OR=1.45，95%CI=1.01~2.09，P=0.04）；治疗2周和6周后HAMD评分差异有统计学意义（MD=-2.04，95%CI=-2.59~-1.49，P<0.000 01；MD=-0.69，95%CI=-1.18~-0.21，P=0.005）；治疗6周后药物不良反应发生率差异有统计学意义（OR=0.88，95%CI=0.78~0.99，P=0.04）。结论 与其他选择性5-HT再摄取抑制药相比较，帕罗西汀的总有效率及起效速度较低，不良反应发生率较高，其不再推荐为一线抗抑郁药。

Abstract:

OBJECTIVE To evaluate the efficacy and safety of paroxetine and other selective 5-HT reuptake inhibitors. METHODS Cochrane Library, web of science, CNKI, VIP, Wanfang Digital Journal Database were retridved. Systematic review(SR) and meta-analysis or randomized controlled trial(RCT) compared paroxetine with other selective 5-HT reuptake inhibitor efficacy and safety. Methodological quality evaluation and meta-analysis of included RCTs, referenced to SR and meta analysis conclusions. RESULTS A total of 15 RCTs were included in the comparison of efficacy and safety of paroxetine with other selective 5-HT reuptake inhibitors. The total effective rate of antidepression in the 2 groups was statistically significant (OR=1.45, 95%CI=1.01-2.09, P=0.04); the difference in HAMD scores after 2 weeks and 6 weeks of treatment was statistically significant(MD=-2.04, 95%CI=-2.59- -1.49, P<0.000 1; MD=-0.69, 95%CI=-1.18- -0.21, P=0.005); the difference in adverse reation after 6 weeks of treatment was statistically significant(OR=0.88, 95%CI=0.78-0.99, P=0.04). CONCLUSION Compared with other selective 5-HT reuptake inhibitors, paroxetine has lower total effective rate and onset rate, and higher incidence of adverse reactions, which is no longer recommended as first-line antidepressant.