OBJECTIVES To assess the clinical efficacy of clozapine in bipolar disorder and its adverse effect profile. METHODS A literature search with no year and no language restriction was conducted. The search yielded 3858 articles, with 2453 remaining after duplicate removal; 9 were suitable for the systematic review. From the 9 included studies, 3 (100 patients treated with clozapine and 102 patients treated with other antipsychotics) could be included in a meta-analysis to test clozapine efficacy in the treatment of manic episodes. RESULTS Clozapine's efficacy was similar to other antipsychotics (Mean difference (MD): 0.03 [95%CI: 0.86-0.92], p = 0.59) in manic episodes. The systematic review also suggested that clozapine is faster at improving symptoms in manic episodes. In addition, two studies included patients with treatment resistant bipolar disorder (TRBD) and showed that clozapine is superior to other treatments for this specific population. Sedation was the most frequent side effect (49.6%), followed by constipation (31.8%) and tachycardia (23.2%). CONCLUSION Clozapine's efficacy was similar to other antipsychotics in manic episodes and is superior to other antipsychotics among TRBD patients.

中文翻译：

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双相情感障碍中的氯氮平：系统评价和荟萃分析。

目的评估氯氮平在双相情感障碍中的临床疗效及其不良反应。方法进行无年限，无语言限制的文献检索。搜索产生3858篇文章，重复删除后剩余2453篇；9个适合系统评价。在纳入的9项研究中，有3项（100例接受氯氮平治疗的患者和102例接受其他抗精神病药治疗的患者）可以纳入荟萃分析，以测试氯氮平在躁狂发作中的疗效。结果在躁狂发作中，氯氮平的疗效与其他抗精神病药相似（均数差（MD）：0.03 [95％CI：0.86-0.92]，p = 0.59）。系统评价还表明，氯氮平在改善躁狂发作症状方面更快。此外，两项研究包括患有抗药性双相情感障碍（TRBD）的患者，并显示对于该特定人群，氯氮平优于其他疗法。镇静是最常见的副作用（49.6％），其次是便秘（31.8％）和心动过速（23.2％）。结论氯氮平在躁狂发作中的疗效与其他抗精神病药相似，并且在TRBD患者中优于其他抗精神病药。