BACKGROUND This systematic review and meta-analysis included double-blind, randomized, placebo-controlled trials of brexpiprazole adjunctive treatment (0.5-3 mg/d) for major depressive disorder where antidepressant treatment had failed. METHODS The outcomes were the response rate (primary), remission rate (secondary), Montgomery Åsberg Depression Rating Scale score (secondary), Sheehan Disability Scale scores (secondary), Clinical Global Impression-Improvement/Severity scores, discontinuation rate, and individual adverse events. A subgroup meta-analysis of the data at week 6 compared outcomes by dose >2 mg/d or ≤2 mg/d (2 mg/d is the recommended dose). RESULTS We identified 9 studies (n = 3391). Compared with placebo, brexpiprazole (any dose) was superior for response rate (risk ratio [RR] = 0.93, 95% confidence interval [95% CI] = 0.89-0.97, number needed to treat = 17), remission rate (RR = 0.95, 95% CI = 0.93-0.98, number needed to treat = 25), Montgomery Åsberg Depression Rating Scale score (standardized mean difference = -0.20, 95% CI = -0.29, -0.11), Sheehan Disability Scale score (standardized mean difference = -0.12, 95% CI = -0.21, -0.04), and Clinical Global Impression-Improvement/Severity scores but was associated with a higher discontinuation rate, akathisia, insomnia, restlessness, somnolence, and weight increase. Doses >2 mg/d had a significantly higher RR for response rate than ≤2 mg/d (0.96 vs 0.89); moreover, compared with placebo, doses >2 mg/d were associated with higher incidences of akathisia (RR = 4.58) and somnolence (RR = 7.56) as well as were marginally associated with a higher incidence of weight increase (RR = 3.14, P = .06). Compared with placebo, doses ≤2 mg/d were associated with higher incidences of akathisia (RR = 2.28) and weight increase (RR = 4.50). CONCLUSIONS Brexpiprazole adjunctive treatment is effective for major depressive disorder when antidepressant treatment fails. At 6 weeks, doses ≤2 mg/d presented a better risk/benefit balance than >2 mg/d.

中文翻译：

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在目前的情节中，使用至少一种抗抑郁药治疗失败后出现的严重抑郁障碍的辅助用布雷哌拉唑：系统评价和荟萃分析。

背景技术这项系统的回顾和荟萃分析包括用于抗抑郁药物治疗失败的主要抑郁症患者的双歧性溴苯哌唑辅助治疗（0.5-3 mg / d）的双盲，随机，安慰剂对照试验。方法结果为缓解率（主要），缓解率（次要），蒙哥马利·奥斯伯格抑郁量表评分（次要），希恩残疾量表评分（次要），临床总体印象-改善/严重程度评分，停药率和个体不良反应事件。第6周对数据进行的亚组荟萃分析按剂量> 2 mg / d或≤2mg / d（建议剂量2 mg / d）比较了结局。结果我们确定了9项研究（n = 3391）。与安慰剂相比，brexpiprazole（任何剂量）的缓解率更高（风险比[RR] = 0.93，95％置信区间[95％CI] = 0.89-0.97，需要治疗的数量= 17），缓解率（RR = 0.95，95％CI = 0.93-0.98，需要治疗的数量= 25），蒙哥马利·奥斯贝格抑郁量表评分（标准平均差异= -0.20，95％CI =- 0.29，-0.11），Sheehan残疾量表评分（标准化平均差异= -0.12、95％CI = -0.21，-0.04）和临床总体印象改善/严重程度评分，但与较高的停药率，静坐不全，失眠相关，躁动，嗜睡和体重增加。剂量> 2 mg / d的患者反应率的RR显着高于≤2mg / d（0.96 vs 0.89）；此外，与安慰剂相比，> 2 mg / d的剂量与静坐症（RR = 4.58）和嗜睡（RR = 7.56）的发生率更高，以及与体重增加的较高发生率（RR = 3.14，P = .06）。与安慰剂相比 剂量≤2mg / d与静坐症的发生率较高（RR = 2.28）和体重增加（RR = 4.50）相关。结论当抗抑郁药治疗失败时，布雷哌拉唑辅助治疗对重度抑郁症有效。在6周时，≤2mg / d的剂量比> 2 mg / d的剂量具有更好的风险/获益平衡。