強迫性障害の薬物療法について・・・ より
Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: an update meta-analysis of double-blind, randomized, placebo-controlled trials.JournalThe international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP). 2015 May 4; pii: pyv047.AuthorMarkus Dold, Martin Aigner, Rupert Lanzenberger, Siegfried KasperAffiliationAbstractBACKGROUND : Many patients with obsessive-compulsive disorder (OCD) do not respond adequately to serotonin reuptake inhibitors (SRIs). Augmentation with antipsychotic drugs can be beneficial in this regard. However, since new relevant randomized controlled trials (RCTs) evaluating new antipsychotics were conducted, a recalculation of the effect sizes appears necessary.METHODS : We meta-analyzed all double-blind, placebo-controlled RCTs comparing augmentation of SRIs with antipsychotics to placebo supplementation in SRI-resistant OCD. Primary outcome was mean change in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score. Secondary outcomes were obsessions, compulsions, response rates, and attrition rates. The data collection process was conducted independently by two authors. Hedges's g and risks ratios were calculated as effect sizes. In pre-planned meta-regressions, subgroup analyses, and sensitivity analyses we examined the robustness of the results and explored reasons for potential heterogeneity.RESULTS : Altogether, 14 double-blind RCTs (n=491) investigating quetiapine (N=4, n=142), risperidone (N=4, n=132), aripiprazole (N=2, n=79), olanzapine (N=2, n=70), paliperidone (N=1, n=34), and haloperidol (N=1, n=34) were incorporated. Augmentation with antipsychotics was significantly more efficacious than placebo in Y-BOCS total reduction (N=14, n=478; Hedges's g=-0.64, 95% CI: -0.87 to -0.41; p=