Akathisia和较新的第二代抗精神病药物：最新证据综述。,Pharmacotherapy

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Akathisia和较新的第二代抗精神病药物：最新证据综述。
Pharmacotherapy ( IF 2.9 ) Pub Date : 2020-04-28 , DOI: 10.1002/phar.2404
Constance L Chow ₁ , Nour K Kadouh ₂ , Jolene R Bostwick ₂ , Amy M VandenBerg ₃

Affiliation

静坐症继续在临床实践中提出重大挑战。作为一类非典型或第二代抗精神病药（SGA），是精神分裂症的主要治疗药物，通常用于治疗情绪障碍。传统上，这些药物与第一代抗精神病药的区别在于它们降低了锥体束外副作用（EPS）（例如肌张力障碍，运动障碍，静坐无力和假性帕金森病）的风险。但是，在所有市售的SGA中都已在一定程度上证明了EPS的发生，特别是静坐症。这项审查审查了精神分裂症，躁郁症和重度抑郁症（MDD）患者中9个较新的SGA中静坐症的发生率。我们对PubMed，ClinicalTrials.gov，Cochrane Central Register和Google Scholar进行了搜索，以及制造商网站和已发布和未发布的临床试验，荟萃分析和系统评价的产品标签。评估患有精神分裂症，双相情感障碍或MDD的成年患者的研究符合纳入条件。从每项研究中收集了治疗急诊静坐症的数据，并探讨了潜在的剂量反应关系。该评价共纳入177项研究，涵盖414个治疗组的58,069例患者。与安慰剂的复合性痴呆发生率为3.7％相比，在所纳入的研究中，单个SGA产生的痴呆的总复合发生率为2.9–13.0％。高剂量的SGA通常会导致静坐症的风险增加。

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Akathisia and Newer Second-Generation Antipsychotic Drugs: A Review of Current Evidence.

Akathisia continues to present a significant challenge in clinical practice. As a class, so‐called atypical, or second‐generation, antipsychotics (SGAs) are the mainstay of treatment for schizophrenia and are commonly used to treat mood disorders. These medications have traditionally been distinguished from first‐generation antipsychotics by their lowered risk of extrapyramidal side effects (EPS) such as dystonia, dyskinesia, akathisia, and pseudoparkinsonism. However, the occurrence of EPS, particularly akathisia, has been demonstrated to some degree in all commercially available SGAs. This review examines the incidence of akathisia in nine newer SGAs in patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD). We performed a search of PubMed, ClinicalTrials.gov, Cochrane Central Register, and Google Scholar, as well as manufacturer websites and product labeling for published and unpublished clinical trials, meta‐analyses, and systematic reviews. Studies evaluating adult patients with schizophrenia, bipolar disorder, or MDD were eligible for inclusion. Data on treatment‐emergent akathisia rates were gathered from each study, and potential dose‐response relationships were explored. A total of 177 studies were included in this review, comprising 58,069 patients across 414 treatment arms. Compared with placebo with a composite 3.7% incidence of akathisia, individual SGAs produced akathisia at total composite rates ranging from 2.9–13.0% across the included studies. High doses of an SGA were generally associated with an increased risk of akathisia. Clinicians should consider the risk of akathisia when choosing a treatment option and monitor for akathisia in patients beginning therapy with an SGA or following a dose increase of the SGA.

更新日期：2020-04-28

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