目前市场上治疗抑郁症的药物有很多种,但依然有很多抑郁症患者无法治愈。2008年2月的爱思唯尔期刊《生物精神病学》(Biological Psychiatry)发表的一篇文章,对SNRIs类和SSRIs类抗抑郁药物的疗效进行了对比研究。
研究人员综合分析了34个双盲随机控制试验,SNRIs类药物选用了文拉法辛。文章第一作者Charles Nemeroff博士说:“文拉法辛的效果整体上优于SSRIs类药物。由于副作用,很多文拉法辛受试者中途退出试验。”研究发现文拉法辛在有效率比SSRIs类药物高5.9%。
《生物精神病学》杂志的编辑,同时还受聘于耶鲁大学医学院和美国退役军人协会康涅狄格医疗服务系统的医学博士John H. Krystal说:“这篇文章的研究结论对公共卫生有很重要的意义。”他进一步解释说,如果一名医生一开始用SSRI类药物诊治200名抑郁症患者。后来,他改用文拉法辛治疗,那么将有12名患者从改变用药中获益。这只是一个小数目,但如果占全美人口7.1%(2100多万人)的抑郁症患者都改用文拉法辛,那么有效率提高5.9%将意味着超过一百万人有了治愈抑郁症的希望。(科学网 荔涛/编译)
生物谷推荐原始出处:
(Biological Psychiatry),doi:10.1016/j.biopsych.2007.06.027 ,Charles B. Nemeroff, Michael E. Thase
Comprehensive Analysis of Remission (COMPARE) with Venlafaxine versus SSRIs Charles B. Nemeroffa, , , Richard Entsuahb, Isma Benattiab, Mark Demitrackb, Diane M. Sloanc and Michael E. Thased
aDepartment of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
bWyeth Research, Collegeville, Pennsylvania
cAdvogent, Wayne, New Jersey
dDepartment of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Received 3 November 2006; revised 17 May 2007; accepted 6 June 2007. Available online 24 September 2007.
Background
To compare venlafaxine and selective serotonin reuptake inhibitors (SSRIs; fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram) in the treatment of depression.
Methods and Materials
Meta-analysis of 34 randomized, double-blind studies identified by a worldwide search of all research sponsored by Wyeth Pharmaceuticals through January 2007. Patients were treated with venlafaxine (n = 4191; mean dose 151 mg/day) or SSRIs (n = 3621); nine studies also included a placebo control group (n = 932). The primary outcome measure was intent-to-treat (ITT) remission rates (Hamilton Rating Scale for Depression ≤7) at week 8.
Results
The overall difference in ITT remission rates was 5.9% favoring venlafaxine (95% confidence interval [CI]: .038–.081; p < .001). Based on this difference, the number needed to treat (NNT) to benefit is 17 (95% CI: 12–26). In the nine placebo controlled studies, the drug-placebo differences were 6% (.02–.09) for the SSRIs and 13% (.09–.16) for venlafaxine. For the specific SSRIs, the difference versus fluoxetine (mean dose = 37 mg/day; 20 studies) was significant (6.6% [95% CI: .030–.095]); smaller differences versus paroxetine (mean dose = 25 mg/day; eight studies; 5%), sertraline (mean dose = 127 mg/day; three studies; 3%), and citalopram (mean dose = 38 mg/day; two studies; 4%) were not significant. Attrition rates due to adverse events were higher with venlafaxine than with SSRI therapy, 11% and 9% respectively (p = .0011).
Conclusions
These results indicate that venlafaxine therapy is statistically superior to SSRIs as a class, but only to fluoxetine individually. The clinical significance of this modest advantage seems limited for the broad grouping of major depressive disorder. Nonetheless, an NNT of 17 may be of public health relevance given the large number of patients treated for depression and the significant burden of illness associated with this disorder.