4.3 Article

Clinical Relevance of Treatments for Acute Bipolar Disorder: Balancing Therapeutic and Adverse Effects

期刊

CLINICAL THERAPEUTICS
卷 33, 期 12, 页码 B40-B48

出版社

ELSEVIER
DOI: 10.1016/j.clinthera.2011.11.020

关键词

antipsychotics; bipolar disorder; likelihood to help or harm; mood stabilizers; number needed to harm; number needed to treat

资金

  1. Abbott Labs
  2. AstraZeneca
  3. Bristol-Myers Squibb
  4. Cephalon
  5. Eli Lilly
  6. GlaxoSmithKline
  7. Pfizer
  8. Repligen
  9. Sunovion
  10. Wyeth
  11. Dainippon Sumitomo
  12. Forest
  13. Janssen
  14. Jazz
  15. Merck
  16. Novartis
  17. Organon
  18. Solvay
  19. Valeant
  20. Vanda
  21. XenoPort
  22. National Institute of Mental Health (NIMH)
  23. Agency for Healthcare Research and Quality (AHRQ)
  24. National Alliance for Research on Schizophrenia and Depression (NARSAD)
  25. Pritzker Foundation
  26. Stanley Foundation

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Background: The US Food and Drug Administration (FDA) has approved 10 treatments for acute mania, but only 2 for acute bipolar depression. These agents differ from one another with respect to their efficacy and tolerability profiles, such that certain medications may be optimal for some patients but not others. Objective: Our aim was to compare the therapeutic and adverse effects of treatments for acute mania and acute bipolar depression to inform clinical decision making. Methods: Using data from large, randomized, double-blind, placebo-controlled acute mania and acute bipolar depression trials, we assessed number needed to treat (NNT) for response, number needed to harm (NNH) for sedation/weight gain, and likelihood to help or harm (LHH = NNH divided by NNT) compared with placebo. Results: For acute mania, lithium compared with other FDA-approved agents yielded substantively less sedation (NNH, 27 vs 5-17) yet broadly similar efficacy (NNT, 4 vs 4-8), and thus a more favorable efficacy:sedation likelihood (LHH, 6.8 vs 0.7-3.4). For acute bipolar depression, lamotrigine compared with FDA-approved treatments yielded substantively less sedation (NNH, 42 vs 6-12), weight gain (NNH, -34 vs 6-19), and efficacy (NNT, 12 vs 4-6), but still more favorable efficacy:sedation likelihood (LHH, 3.5) than quetiapine (LHH, 1.0) and efficacy:weight gain likelihood (LHH, -2.8) than the olanzapine plus fluoxetine combination (LHH, 1.5). Conclusions: For acute mania, lithium compared with other FDA-approved agents yielded less sedation yet similar efficacy, indicating utility for patients sensitive to sedation. For acute bipolar depression, lamotrigine compared with FDA-approved treatments yielded better tolerability but poorer efficacy, suggesting utility in patients sensitive to sedation/weight gain with milder episodes, whereas the FDA-approved treatments might have utility in patients with more severe episodes. (Clin Ther. 2011;33:B40-B48) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.

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