对5-羟色胺再摄取抑制剂部分应答的强迫症增效药物的临床建议

摘要(中文译文)

强迫症（OCD）影响全球2%至3%的成年人。尽管5-羟色胺再摄取抑制剂（SRIs）对该病症确实显示出疗效，但40%至60%的患者仅获得部分缓解。本系统综述的目的是评估其他药物的疗效，这些药物可作为对SRI单药治疗仅部分应答患者的增效药物。依据PRISMA-P指南，使用随机对照试验（RCT）过滤器及关键词“强迫症”检索PubMed和Embase。要纳入分析，潜在的增效药物需至少有2项RCT。本综述专门分析每种增效药物对强迫症症状的影响，以耶鲁-布朗强迫量表（Yale-Brown Obsessive-Compulsive Scale）衡量。本综述分析的增效药物包括：d-环丝氨酸（2项RCT）、美金刚（4项RCT）、N-乙酰半胱氨酸（5项RCT）、拉莫三嗪（2项RCT）、托吡酯（3项RCT）、利鲁唑（2项RCT）、昂丹司琼（2项RCT）、塞来昔布（2项RCT）、阿立哌唑（5项RCT）、利培酮（7项RCT）、喹硫平（9项RCT）和奥氮平（3项RCT）。本综述最支持的用于SRI单药治疗仅部分应答的强迫症的增效药物为拉莫三嗪、美金刚和阿立哌唑。若必须使用抗精神病药物且阿立哌唑不能耐受，可考虑利培酮作为替代。与SRI类药物对强迫症症状减轻的类别效应不同，增效药物显示出相当大的类别内变异性。

Abstract

Obsessive-compulsive disorder (OCD) affects 2% to 3% of adults worldwide. Although serotonin reuptake inhibitors (SRIs) reliably demonstrate efficacy for this condition, 40% to 60% of patients only achieve partial recovery. The purpose of this systematic review was to assess the efficacy of other agents that may be used as augmentation agents for patients who are partial responders to SRI monotherapy. Using PRISMA-P guidelines, PubMed and Embase were searched using the randomized controlled trial (RCT) filter and the key word "obsessive-compulsive disorder." To be considered for analysis, a potential augmentation agent needed to have at least 2 RCTs. This review specifically analyzes the effect of each augmentation agent on OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale. The augmentation agents analyzed in this review are d -cycloserine (2 RCTs), memantine (4 RCTs), N -acetylcysteine (5 RCTs), lamotrigine (2 RCTs), topiramate (3 RCTs), riluzole (2 RCTs), ondansetron (2 RCTs), celecoxib (2 RCTs), aripiprazole (5 RCTs), risperidone (7 RCTs), quetiapine (9 RCTs), and olanzapine (3 RCTs). The augmentation agents most supported by this review for OCD that is only a partial response to SRI monotherapy are lamotrigine, memantine, and aripiprazole. If an antipsychotic must be used and aripiprazole is not tolerated, risperidone may be considered as an alternative. Unlike the SRI class effect for OCD symptom reduction, augmentation agents demonstrate considerable intraclass variability.

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