Intervention Review

Olanzapine in long-term treatment for bipolar disorder

  1. Andrea Cipriani1,*,
  2. Jennifer M Rendell2,
  3. John Geddes2

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 8 DEC 2007

DOI: 10.1002/14651858.CD004367.pub2


How to Cite

Cipriani A, Rendell JM, Geddes J. Olanzapine in long-term treatment for bipolar disorder. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD004367. DOI: 10.1002/14651858.CD004367.pub2.

Author Information

  1. 1

    University of Verona, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, Verona, Italy

  2. 2

    University of Oxford, Department of Psychiatry, Oxford, UK

*Andrea Cipriani, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico "G.B.Rossi", Piazzale L.A. Scuro, 10, Verona, 37134, Italy. andrea.cipriani@univr.it. andrea.cipriani@psych.ox.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Background

Many patients with bipolar disorder require long-term treatment to prevent recurrence. Antipsychotic drugs are often used to treat acute manic episodes. It is important to clarify whether olanzapine could have a role in long-term prevention of manic and depressive relapses.

Objectives

To assess the effects of olanzapine, as monotherapy or adjunctive treatment, in preventing manic, depressive and mixed episodes in patients with bipolar affective disorder.

Search methods

We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (September 2006), the Cochrane Central Register of Controlled Trials (September 2006), MEDLINE (1966-December 2007), EMBASE (1980-2006), CINAHL (1982-2006), PsycINFO (1872-2006) and reference lists. We also contacted experts, trialists and pharmaceutical companies in the field.

Selection criteria

Randomised controlled trials comparing olanzapine with placebo or other active treatment in long-term treatment of bipolar disorder.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information.

Main results

Five trials (1165 participants) were included in the review. There was no statistically significant difference between olanzapine and placebo (either alone or in combination with lithium or valproate) in terms of number of participants who experienced relapse into mood episode (random effects RR 0.68, 95% CI 0.43 to 1.07, p = 0.09; 2 studies, n=460), however restricting the analysis to the trial that compared olanzapine monotherapy versus placebo, there was a statistically significant difference in favour of olanzapine (RR 0.58, 95% CI 0.49 to 0.69, p<0.00001). No statistically significant difference was found between olanzapine and other mood stabilisers (lithium or valproate) in preventing symptomatic relapse for any mood episode, however, olanzapine was more effective than lithium in preventing symptomatic manic relapse (RR 0.59, 95% CI 0.39 to 0.89, p = 0.01; 1 study, n=361). Olanzapine either alone or as adjunctive treatment to mood stabilisers was associated with significantly greater weight gain than placebo. By contrast, olanzapine was associated with a lower rate of manic worsening, but with a higher rate of weight increase and depression than lithium.

Authors' conclusions

Though based on a limited amount of information, there is evidence that olanzapine may prevent further mood episodes in patients who have responded to olanzapine during an index manic or mixed episode and who have not previously had a satisfactory response to lithium or valproate. However, notwithstanding these positive results, the current evidence is stronger for lithium as first line maintenance treatment of bipolar disorder.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Olanzapine in long-term treatment for bipolar disorder

Bipolar affective disorder is a severe and common mental illness, characterised by periods of mania, depression and "mixed episodes" (or "dysphoric mania": a mixture of manic and depressed symptoms). Antipsychotic drugs are often used to treat acute manic episodes and one commonly used antipsychotic drug that has recently been approved for use in mania in USA and Europe is olanzapine. This review considered the efficacy, acceptability and adverse effects of olanzapine in long-term treatment of bipolar disorder in comparison with placebo or other active drug comparisons. Five trials (1165 participants) met the inclusion criteria and are included in the review. Based on a limited amount of information, olanzapine may prevent further mood episodes (especially manic relapse) in patients who responded to olanzapine during an index manic or mixed episode and who have not previously had a satisfactory response to lithium or valproate. The olanzapine group had significantly fewer patients suffering from insomnia than the placebo group, but a significantly larger number of people suffering from weight gain. When compared with lithium, olanzapine caused more weight gain and depressive symptoms but fewer insomnia and nausea symptoms and a lower rate of manic worsening. However, considering the lack of clear findings of this review, conclusions on efficacy and acceptability of olanzapine compared to placebo, lithium or valproate cannot be made with any degree of confidence

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

使用olanzapine(奥氮平)进行双相情感障碍的长期治疗

研究背景

许多双相情感障碍患者需要接受长期治疗以避免复发。抗精神病药物常被用于治疗急性躁狂发作。明确olanzapine能否长期预防躁狂和抑郁复发有其重要意义。

研究目的

评价olanzapine单独或联合疗法能否有效预防双相情感障碍患者的躁狂症状、抑郁症状以及两者混合发作。

检索方法

检索了Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register(截至2006年9月),Cochrane Central Register of Controlled Trials(截至2006年9月),MEDLINE(1966–2007年12月),EMBASE(1980–2006年),CINAHL(1982–2006年),PsycINFO(1872–2006年)等数据库,以及相关参考文献。我们还联系了该领域的专家、试验人员及制药公司等。

纳入标准

比较olanzapine与安慰剂或其他药物对双相情感障碍长期疗效的随机对照试验。

数据收集与分析

两位评价者独立地评价研究质量并提取资料。联系原作者获取更多信息。

主要结果

共纳入五个试验(n=1165)。结果发现,olanzapine(包括单独用药或与lithium(锂剂)或valproate(2−丙基戊酸钠)联用)与安慰剂组相比,在复发人数上没有差异(2个试验,n=460;随机效应模型RR=0.68, 95%CI: 0.43–1.07, p=0.09)。如果仅分析olanzapine单独治疗组与安慰剂的比较,则olanzapine疗效优于安慰剂(RR=0.58, 95%CI: 0.49–0.69, p<0.00001)。olanzapine与其他情绪稳定剂(lithium或valproate)相比,对所有症状复发的整体预防效果并无差异,若仅以躁狂发作为结局指标,则olanzapine的预防效果优于lithium(1个试验,n=361;RR=0.59,95%CI: 0.39–0.89, p=0.01)。不良反应方面,无论是olanzapine单独疗法或与其他情绪稳定剂联用,试验组的体重增加率都显著高于安慰剂组。与lithium相比,olanzapine较少引起躁狂症加重,但发生体重增加和抑郁的几率增加。

作者结论

有限的证据显示,对于躁狂发作或混合发作时olanzapien治疗有效的患者,以及使用lithium或valproate疗效欠佳的患者,olanzapine可能有助于预防进一步的发作。尽管如此,目前的证据仍偏向于将lithium作为双相情感障碍维持治疗的一线药物。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

使用olanzapine(奥氮平)进行双相情感障碍的长期治疗

使用olanzapine进行双向情感障碍的长期治疗

双相情感障碍是一种常见的严重精神疾病,主要表现为周期性的躁狂发作、抑郁发作或者“混合发作”(又称“焦虑性躁狂”,一种躁狂和抑郁症状的混合状态)。抗精神病药物常常被用于治疗急性躁狂发作,olanzapine是一种常用的抗精神病药物,近期被美国和欧洲批准用于治疗躁狂症。本系统评价对olanzapine用于双相情感障碍长期治疗的有效性、可接受性和不良反应方面,与安慰剂或其他药物进行了比较。本研究共纳入五个符合纳入标准的试验(n=1165)。有限的证据表明,对于躁狂发作或混合发作时olanzapien治疗有效的患者,以及使用lithium或valproate疗效欠佳的患者, olanzapine可能有助于预防进一步的发作(尤其是躁狂)。Olanzapine组出现失眠症状者少于安慰剂组,但体重增加者多于安慰剂组。与lithium相比,olanzapine组伴有更多的体重增长和抑郁症状,而失眠、恶心和躁狂恶化均较少。由于本研究未得出有确切证据的结论,因此olanzapine与安慰剂、lithium 或 valproate相比的有效性和可接受度尚不能确定。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

背景

使用olanzapine進行雙極性情感疾患的長期治療

很多罹患雙極性情感疾患的病人需要接受長期治療以預防復發。抗精神病藥物常被使用於治療急性躁症發作,很重要的是要澄清是否在長期預防躁症及鬱症復發olanzapine有其角色。

目標

評估罹患雙極性情感疾患的病人,使用olanzapine於單一治療或加成治療時,是否能預防躁症、鬱症及混合發作。

搜尋策略

我們搜尋Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register(2006年9月), Cochrane Central Register of Controlled Trials(2006年9月), MEDLINE(1966年至2007年12月),EMBASE(1980年至2006年),CINAHL(1982年至2006年), PsycINFO(1872年至2006年),及其相關的參考文獻。我們也接洽連絡這領域專家、試驗人員及藥商公司。

選擇標準

比較olanzapine與安慰劑或其他的積極治療,使用於雙極性情感疾患長期治療的隨機試驗。

資料收集與分析

兩位回顧作者獨立評估試驗的品質及提取資料。我們與研究作者接洽取得其他額外的資料。

主要結論

此回顧共納入了五個試驗(1165位參與者)。olanzapine與安慰劑(無論獨自治療或與lithium或depakine併用)在參與者經歷復發數目上沒有統計上的差異(於2個研究試驗,460位個案數中,以隨機效應計算的相對危險為(random effects RR)0.68,95%信賴區間(CI)0.43到1.07, p = 0.09),然而若限制分析在試驗為比較olanzapine單獨治療與安慰劑,就有統計上的差異,olanzapine比較優勢,相對危險為0.58,95%信賴區間(CI)0.49至0.69, p<0.00001)。olanzapine與其他情緒穩定劑(lithium或valproate)在預防任何的症狀復發並無差異,然而以預防躁症復發來看,olanzapine是優於lithium(在1個361位試驗者的研究中相對危險為0.59,95%信賴區間(CI)0.39至0.89, p = 0.01)。Olanzapine不論是獨自治療或加成情緒穩定劑治療都顯著優於安慰劑。相對下,olanzapine相較於lithium有比較低的躁症惡化比率,有較高的增加體重比率及憂鬱發作比率。

作者結論

雖然基於有限的資料,證據顯示olanzapine可能對在躁症或混合發作對olanzapien有反應的患者及對lithium或valproate過去反應不佳的病人可能可以預防進一步的情緒症狀發作。然而,儘管有這些正面的結果,目前的證據強力顯示lithium仍是作為第一線治療雙極性情感疾患的維持藥物。

翻譯人

本摘要由彰化基督教醫院許文郁翻譯。

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

總結

使用olanzapine進行雙極性情感疾患的長期治療。雙極性情感疾患是一種嚴重且常見的精神疾病,其特徵是一段期間出現躁症、鬱症和混合發作(或不悅躁症:混合躁和鬱的症狀)。抗精神病藥物常常被用來治療急性躁症發作,olanzapine一個常用的抗精神病藥物,在美國和歐洲最近被批准使用於躁症。本次回顧想要了解olanzapine與安慰劑或其他有療效的藥物治療,於雙極性情感疾患長期治療的療效性,可接受性和副作用比較。5個試驗(共1165位參與者)符合納入標準,納入此回顧。基於有限的資料,olanzapine可能對在躁症或混合發作對olanzapien有反應的患者及對lithium或valproate過去反應不佳的患者可能可以預防進一步情緒症狀發作(特別是躁症復發)。olanzapine組相對於安慰劑組有明顯減少失眠,但顯著較多的人增加體重。與lithium比較,olanzapien造成更多的增加體重及憂鬱症狀,但較少的失眠及噁心症狀及更少的躁症惡化。不過考慮到此回顧缺乏明確的結果,本次比較olanzapine、安慰劑、lithium和valproate的有效性和可接受性,無法做出任何程度可信賴的結論。