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Olanzapine alone or in combination for acute mania

  • Review
  • Intervention

Authors


Abstract

Background

Olanzapine, an atypical antipsychotic, is used in the treatment of mania both as monotherapy and combined with other medicines.

Objectives

To review the efficacy and tolerability of olanzapine in the treatment of mania

Search methods

The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, CINAHL and PsycINFO were searched.

Selection criteria

Randomised trials comparing olanzapine with placebo or other drug in acute manic or mixed episodes.

Data collection and analysis

Two reviewers independently extracted data from trial reports

Main results

Six trials (1422 participants) were included in the review. There was a high rate of failure to complete treatment on all treatments which may have biased the estimates of relative efficacy. Olanzapine was superior to placebo at reducing manic symptoms as monotherapy (Young Mania Rating Scale (YMRS) - weighted mean difference (WMD): -5.94, 95% CI -9.09 to -2.80) and in combination with lithium/valproate (YMRS) (WMD -4.01, 95% confidence interval -6.06 to -1.96). Olanzapine monotherapy was superior at reducing psychotic symptoms (PANSS positive symptoms subscale WMD: -3.54, 95% CI -5.28 to -1.80). Olanzapine was superior to divalproex at reducing manic symptoms (standardised mean difference (SMD): -0.29, 95% CI -0.50 to -0.08). Olanzapine did not lead to a statistically higher rate of clinical response than haloperidol (RR: 1.03, 95% CI 0.77 to 1.38). Fewer patients discontinued treatment on olanzapine than placebo (RR: 0.62, 95% CI 0.48 to 0.80). Olanzapine caused greater weight gain than placebo (WMD 1.91Kg, 95% CI 1.29 to 2.53) and somnolence (RR: 2.13 95% CI 1.62 to 2.79) but not more depressive symptoms (RR: 0.95, 95% CI 0.65 to 1.40) or movement disorder (WMD: -0.33, 95% CI -0.74 to 0.09). Olanzapine caused more prolactin elevation than placebo (RR: 4.35 95%CI 1.77 to 10.70). Olanzapine caused greater weight gain (WMD: 1.54, 95% CI 1.02 to 2.05); somnolence (RR: 1.80 95% CI 1.32 to 2.46) and movement disorders (SAS - WMD: 0.72 95% CI 0.11 to 1.33) than divalproex but less nausea ( RR: 0.36 95% CI 0.20 to 0.65). Olanzapine caused more weight gain than haloperidol (RR: 3.59, 95% CI 1.49 to 8.64) but less movement disorder (EPS RR: 0.10, 95% CI 0.04 to 0.24).

Authors' conclusions

Olanzapine is an effective treatment for mania and may be more efficacious than divalproex, though leads to more weight gain. Clinicians should consider both the relative efficacy and the different incidence of specific adverse effects of available drugs.

摘要

背景

Olanzapine對急性躁症單獨或合併治療

Olanzapine是一種非典型抗精神病藥,被單獨或合併其他藥物來治療躁症.

目標

回顧olanzapine在治療躁症上的效果及耐受性.

搜尋策略

搜尋the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, CINAHL and PsycINFO.

選擇標準

選擇在治療躁症發作或混合發作上,比較olanzapine和安慰劑或其他藥物的隨機試驗.

資料收集與分析

兩位回顧者獨立分析實驗結果.

主要結論

6個試驗(1422參與者)被納入這個回顧研究. 高比率失敗而未能完成所有治療可能影響估計相對的效果. Olanzapine單獨使用在降低躁症症狀,比安慰劑有較佳的效果.(Young Mania Rating Scale (YMRS)  weighted mean difference (WMD): −5.94, 95% CI −9.09 to −2.80). 合併使用lithium/valproate (YMRS)也有同樣的結論(WMD −4.01, 95% confidence interval −6.06 to −1.96). Olanzapine 單獨使 用在降低精神症狀有較佳的效果.(PANSS positive symptoms subscale WMD: −3.54, 95% CI −5.28 to −1.80). Olanzapine 使 用在降低躁症症狀, 比divalproex有 較佳的效果.(standardised mean difference (SMD): −0.29, 95% CI −0.50 to −0.08). Olanzapine 對 比 haloperidol在統計上並 沒有較高的臨床反應(RR: 1.03, 95% CI 0.77 to 1.38). olanzapine 對 比安慰劑有較低的退出率(RR: 0.62, 95% CI 0.48 to 0.80). olanzapine 對比安慰 劑造成較多的體重增加(WMD 1.91Kg, 95% CI 1.29 to 2.53),嗜睡(RR: 2.13 95% CI 1.62 to 2.79),但是較不會有憂鬱症狀(RR: 0.95, 95% CI 0.65 to 1.40)或運動疾患(WMD: −0.33, 95% CI −0.74 to 0.09). olanzapine 對比安慰 劑較容易造成泌乳激素升高.(RR: 4.35 95%CI 1.77 to 10.70). olanzapine 對比divalproex造 成較多的體重增加(WMD: 1.54, 95% CI 1.02 to 2.05),嗜睡(RR: 1.80 95% CI 1.32 to 2.46), 運動疾患(SAS  WMD: 0.72 95% CI 0.11 to 1.33),但較不會造成噁心(RR: 0.36 95% CI 0.20 to 0.65). Olanzapine 對 比 haloperidol造成較多的 體重增加(RR: 3.59, 95% CI 1.49 to 8.64),但是較少的運動疾患(EPS RR: 0.10, 95% CI 0.04 to 0.24).

作者結論

Olanzapine儘管造成較多體重增加,是個對躁症有效的治療方式,且可能比divalproex更具療效. 臨床醫師應將相對療效及可用藥物之特定副作用之不同發生率做通盤考量.

翻譯人

本摘要由彰化基督教醫院張庭綱翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

此回顧研究包含6個試驗,且探討olanzapine對比安慰劑或其他藥物在治療躁症上之效果及耐受性. 高退出率限制了本試驗的可信度. Olanzapine儘管贈成體重增加,單獨使用或合併情緒穩定劑在降低躁症症狀,比安慰劑有較佳的效果. Olanzapine比divalproex更具療效且造成較少的噁心感,但卻引起較多的體重增加,嗜睡及運動疾患. Olanzapine和haloperidol在療效上是可比擬的,但卻有較少的運動疾患,較多的體重增加.

Plain language summary

Olanzapine compared to placebo or other medicine as treatment for mania

High withdrawal rates from the trials limit the confidence that can be placed on the results. Olanzapine was superior to placebo in reduction of manic symptoms both as monotherapy and combined with mood stabilizers, though caused weight gain. Olanzapine was more efficacious than divalproex and caused less nausea but more weight gain, somnolence and movement disorders. Olanzapine was comparable to haloperidol in efficacy, caused less movement disorders but greater weight gain.

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