机构：[a]National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China[b]Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China[c]Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China广东省人民医院[d]Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China[e]The University of Notre Dame Australia / Marian Centre, & Graylands Hospital, Perth, Australia[f]Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia[g]Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China[h]The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA[i]Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA[j]Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
Treatment-resistant schizophrenia (TRS) is common and debilitating. A subgroup of patients even has clozapine-resistant schizophrenia (CRS). We aimed to evaluate the efficacy and safety of electroconvulsive therapy (ECT) augmentation of clozapine for CRS. Systematic literature search of randomized controlled trials (RCTs) reporting on ECT augmentation of clozapine in CRS. Co-primary outcomes included symptomatic improvement at post-ECT assessment and study endpoint. Eighteen RCTs (n = 1769) with 20 active treatment arms were identified and meta-analyzed. Adjunctive ECT was superior to clozapine regarding symptomatic improvement at post-ECT assessment (Standardized Mean Difference (SMD) = -0.88, 95% Confidence Interval (CI): -1.33 to -0.44; I2 = 86%, P = 0.0001) and endpoint assessment (SMD: -1.44, 95%CI: -2.05 to -0.84; I2 = 95%, P < 0.00001), separating as early as week 1-2 (SMD = -0.54, 95%CI: -0.88 to -0.20; I2 = 77%, P = 0.002). Adjunctive ECT was also superior regarding study-defined response at post-ECT assessment (53.6% vs. 25.4%, Risk Ratio (RR) = 1.94, 95%CI: 1.59-2.36; I2 = 0%, P < 0.00001, number-needed-to-treat (NNT) = 3, 95%CI: 3-5) and endpoint assessment (67.7% vs. 41.4%, RR = 1.66, 95%CI: 1.38-1.99; I2 = 47%, P < 0.00001, NNT = 4, 95%CI: 3-8), and remission at post-ECT assessment (13.3% vs. 3.7%, RR = 3.28, 95%CI: 1.80-5.99; I2 = 0%, P = 0.0001, NNT = 13, 95%CI: 6-100) and endpoint assessment (23.6% vs. 13.3%, RR = 1.80, 95%CI: 1.39 to 2.35; I2 = 5%, P < 0.0001, NNT = 14, 95%CI: 6-50). Patient-reported memory impairment (24.2% vs. 0%; RR = 16.10 (95%CI: 4.53-57.26); I2 = 0%, P < 0.0001, number-needed-to-harm (NNH) = 4, 95%CI: 2-14) and headache (14.5% vs 1.6%; RR = 4.03 (95%CI: 1.54-10.56); I2 = 0%, P = 0.005, NNH = 8, 95%CI: 4-50) occurred more frequently with adjunctive ECT. No significant group differences were found regarding discontinuation and other adverse effects. Despite increased frequency of self-reported memory impairment and headache, ECT augmentation of clozapine is a highly effective and relatively safe treatment for CRS.
CRD42018089959.
基金：
the University of Macau (MYRG2015-
00230-FHS; MYRG2016-00005-FHS), National Key Research &
Development Program of China (No. 2016YFC1307200), Beijing
Municipal Administration of Hospitals Clinical Medicine Development
of Special Funding Support (No. ZYLX201607) and Beijing Municipal
Administration of Hospitals’ Ascent Plan (No. DFL20151801).
第一作者机构：[a]National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
共同第一作者：
通讯作者：
通讯机构：[g]Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China[*a]Faculty of Health Sciences, University of Macau, Avenida da Universidade, 3/F, Building E12, Taipa, Macau, SAR, China.
推荐引用方式(GB/T 7714)：
Gang Wang,Wei Zheng,Xian-Bin Li,et al.ECT augmentation of clozapine for clozapine-resistant schizophrenia: A meta-analysis of randomized controlled trials.[J].JOURNAL OF PSYCHIATRIC RESEARCH.2018,105:23-32.doi:10.1016/j.jpsychires.2018.08.002.
APA：
Gang Wang,Wei Zheng,Xian-Bin Li,Shi-Bin Wang,Dong-Bin Cai...&Christoph U. Correll.(2018).ECT augmentation of clozapine for clozapine-resistant schizophrenia: A meta-analysis of randomized controlled trials..JOURNAL OF PSYCHIATRIC RESEARCH,105,
MLA：
Gang Wang,et al."ECT augmentation of clozapine for clozapine-resistant schizophrenia: A meta-analysis of randomized controlled trials.".JOURNAL OF PSYCHIATRIC RESEARCH 105.(2018):23-32
