| 引用本文: | 刘悦,叶珊,化晓凯,刘芳.奥卡西平与卡马西平对前庭阵发症的疗效及安全性比较的meta分析[J].中国现代应用药学,2023,40(15):2140-2147. |
| LIU Yue,YE Shan,HUA Xiaokai,LIU Fang.Meta-analysis of Efficacy and Safety of Oxcarbazepine and Carbamazepine in the Treatment of Vestibular Paroxysmia[J].Chin J Mod Appl Pharm(中国现代应用药学),2023,40(15):2140-2147. |
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| 奥卡西平与卡马西平对前庭阵发症的疗效及安全性比较的meta分析 |
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刘悦1,2, 叶珊3, 化晓凯4, 刘芳1
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1.北京大学第三医院药剂科, 北京 100191;2.山东中医药大学附属医院药剂科, 济南 250014;3.北京大学第三医院神经内科, 北京 100191;4.山东中医药大学第二附属医院药剂科, 济南 250001
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| 摘要: |
| 目的 系统评价奥卡西平(oxcarbazepine，OXC)治疗前庭阵发症(vestibular paroxysmia，VP)的疗效和安全性是否优于卡马西平(carbamazepine，CBZ)。方法 计算机检索PubMed、Cochrane Library、Embase、万方、中国知网、维普、中国生物医学文献服务系统(SinoMed)，收集直接比较OXC和CBZ治疗VP的随机对照研究(randomized controlled trials，RCT)，检索时限为建库以来到2022年4月，使用RevMan5.4软件对临床总有效率、眩晕障碍程度评定(dizziness handicap inventory，DHI)评分、发作频率、眩晕程度、焦虑自评量表(self-rating anxiety scale，SAS)评分、抑郁自评量表(self-rating depression scale，SDS)评分、不良反应发生率7个结局指标进行meta分析，按照GRADE标准对结局指标进行证据质量评价。结果 共纳入6项RCT，包含425例患者，其中OXC组211例，CBZ组214例。Meta分析显示，OXC和CBZ在治疗VP总有效率[RR=1.04，95％CI(0.90，1.20)，P=0.57]和降低VP患者眩晕程度[SMD=-0.80，95%CI(-2.14，0.54)，P=0.24]方面无明显差异；OXC组在降低患者DHI评分[MD=-8.81，95%CI(-14.59，-3.03)，P=0.003]、发作频率[SMD=-1.86，95%CI(-3.32，-0.41)，P=0.01]、SAS评分[MD=-7.77，95%CI(-14.09，-1.46)，P=0.02]、SDS评分[MD=-10.45，95%CI(-15.36，-5.54)，P<0.000 1]方面均优于CBZ组，且不良反应较少[RR=0.43，95％CI(0.29，0.63)，P<0.000 1]。GRADE证据质量评价显示，不良反应发生率为低质量证据，其余指标为极低质量证据。结论 OXC对眩晕发作频率、生活质量、抑郁焦虑状态的改善效果优于CBZ，且不良反应较少。但目前研究的样本量较小，证据级别较低，因此还需更多大样本、高质量的临床研究进一步分析证实。 |
| 关键词: 奥卡西平 卡马西平 前庭阵发症 疗效 安全性 meta分析 GRADE评价 |
| DOI：10.13748/j.cnki.issn1007-7693.20222825 |
| 分类号:R969.3 |
| 基金项目:首都卫生发展科研专项项目(2020-1-2031)；山东省药品临床综合评价项目(2021YZ003) |
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| Meta-analysis of Efficacy and Safety of Oxcarbazepine and Carbamazepine in the Treatment of Vestibular Paroxysmia |
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LIU Yue,YE Shan,HUA Xiaokai,LIU Fang
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1.Peking University Third Hospital, Department of PharmacyBeijing 100191, China;2.Department of Pharmacy, Affiliated Hospital of Shandong University of Traditional Chinese Medicine(TCM), Jinan 250014, China;3.Peking University Third Hospital, Department of Neurology, Beijing 100191, China
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| Abstract: |
| OBJECTIVE To systematically evaluate the efficacy and safety of oxcarbazepine(OXC) and carbamazepine(CBZ) in the treatment of vestibular paroxysmia(VP). METHODS Randomized controlled trials(RCTs) comparing OXC and CBZ in treating VP were searched in PubMed, Cochrane Library, Embase, Wanfang, CNKI, VIP, China Biomedical Literature Database(SinoMed), from the establishment of the database to April 2022. RevMan5.4 software was used to perform meta-analysis on outcomes including total effective rate, the dizziness handicap inventory(DHI) score, attack frequency, degree of vertigo, self-rating anxiety scale(SAS) score, self-rating depression scale(SDS) score and adverse reactions. The quality of evidence for each outcome was evaluated using GRADE standard. RESULTS A total of 6 RCTs were included with a total sample size of 425 cases, including 211 cases in the OXC group and 214 cases in the CBZ group. Meta analysis results showed that there was no significant difference in the total effective rate in treating VP[RR=1.04, 95%CI(0.90, 1.20), P=0.57] and the degree of vertigo[SMD=-0.80, 95%CI(-2.14, 0.54), P=0.24]; OXC group was lower than CBZ group in DHI score[MD=-8.81, 95%CI(-14.59, -3.03), P=0.003], attack frequency[SMD=-1.86, 95%CI(-3.32, -0.41), P=0.01], SAS score[MD=-7.77, 95%CI(-14.09, -1.46), P=0.02], SDS score[MD=-10.45, 95%CI(-15.36,-5.54), P<0.000 1] and had fewer adverse reactions[RR=0.43, 95%CI(0.29, 0.63), P<0.000 1]. GRADE evidence quality evaluation showed that the quality for the adverse reactions rate was low and the quality for the other index was very low. CONCLUSION Compared with CBZ, OXC has better effects on the frequency of vertigo attacks, quality of life, depression and anxiety and adverse reactions. However, the sample size of the current studies is small and the evidence is low-quality. Large-sample, high-quality RCTs are need to provide further evidence. |
| Key words: oxcarbazepine carbamazepine vestibular paroxysmia efficacy safety meta-analysis GRADE evaluation |
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