Efficacy and safety of atypical antipsychotics combined with selective serotonin reuptake inhibitors in the treatment of refractory obsessive-compulsive disorder： a network Meta-analysis / 四川精神卫生

ABSTRACT

ObjectiveTo evaluate the efficacy and safety of 7 atypical antipsychotics combined with selective serotonin reuptake inhibitors（SSRIs） in the treatment of refractory obsessive-compulsive disorder by network Meta-analysis. MethodsRandomized controlled trials （RCTs） about atypical antipsychotics and SSRIs in the treatment of refractory obsessive-compulsive disorder were searched in CNKI， Wanfang Data， VIP， CBM， PubMed， Embase and Cochrane Library databases from inception to June 2020. Based on inclusion and exclusion criteria， the literature screening， date extraction and assessing risk of bias were performed by two researchers independently. Then all statistical analyses were performed using Stata 15.0 software. ResultsA total of 36 RCTs covering 7 atypical antipsychotics and 2 362 patients were included. Network Meta-analysis showed that the surface under the cumulative ranking （SUCAR） of total response rate was the largest in Olanzapine + SSRIs， followed by Paliperidone + SSRIs， Amisulpride + SSRIs， Risperidone + SSRIs， Quetiapine + SSRIs， Ziprasidone + SSRIs， Aripiprazole + SSRIs， SSRIs， and Placebo + SSRIs in turn. In terms of Hamilton Anxiety Scale （HAMA） score， the SUCAR was the largest in Amisulpride + SSRIs， followed by Aripiprazole + SSRIs， Quetiapine + SSRIs， Risperidone + SSRIs， and SSRIs in turn. In terms of Treatment Emergent Symptom Scale （TESS） score， the SUCAR was the largest in Amisulpride + SSRIs， followed by SSRIs， Paliperidone + SSRIs， Quetiapine + SSRIs， Ziprasidone + SSRIs， Risperidone + SSRIs， Aripiprazole + SSRIs， and Placebo + SSRIs in turn. ConclusionCompared with single application of SSRIs， its combination with atypical antipsychotics achieves better efficacy and higher safety in treating refractory obsessive-compulsive disorder， with Olanzapine+SSRIs being the most effective and Amisulpride+SSRIs the safest.