A systematic review and random-effects model network meta-analysis was conducted to compare the efficacy, acceptability, tolerability, and safety of pharmacological interventions for adults with acute bipolar mania. We searched PubMed, the Cochrane Library, and Embase databases for eligible studies published before March 14, 2021. Randomized controlled trials (RCTs) of oral medication monotherapy lasting ≥10 days in adults with mania were included, and studies that allowed the use of antipsychotics as a rescue medication during a trial were excluded. The primary outcomes were response to treatment (efficacy) and all-cause discontinuation (acceptability). The secondary outcomes were the improvement of mania symptoms and discontinuation due to inefficacy. Of the 79 eligible RCTs, 72 double-blind RCTs of 23 drugs and a placebo were included in the meta-analysis (mean study duration = 3.96 ± 2.39 weeks, n = 16442, mean age = 39.55 years, with 50.93% males). Compared with the placebo, aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone outperformed response to treatment (N = 56, n = 14503); aripiprazole, olanzapine, quetiapine, and risperidone had lower all-cause discontinuation; however, topiramate had higher all-cause discontinuation (N = 70, n = 16324). Compared with the placebo, aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone outperformed the improvement of mania symptoms (N = 61, n = 15466), and aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, valproate, and ziprasidone had lower discontinuation due to inefficacy (N = 50, n = 14284). In conclusions, these antipsychotics, carbamazepine, lithium, tamoxifen, and valproate were effective for acute mania. However, only aripiprazole, olanzapine, quetiapine, and risperidone had better acceptability than the placebo.

进行了系统评价和随机效应模型网络荟萃分析，以比较药物干预措施对成人急性双相躁狂症的有效性、可接受性、耐受性和安全性。我们检索了 PubMed、Cochrane 图书馆和 Embase 数据库，查找 2021 年 3 月 14 日之前发表的符合条件的研究。其中包括对成人躁狂症患者持续≥10 天的口服药物单药治疗的随机对照试验 (RCT)，以及允许使用抗精神病药物的研究作为试验期间的救援药物被排除在外。主要结局是对治疗的反应（疗效）和全因停药（可接受性）。次要结局是躁狂症状的改善和因无效而停药。在 79 项符合条件的随机对照试验中，荟萃分析纳入了 72 项涉及 23 种药物和安慰剂的双盲随机对照试验（平均研究持续时间 = 3.96 ± 2.39 周， n = 16442，平均年龄 = 39.55 岁，其中 50.93% 为男性）。与安慰剂相比，阿立哌唑、阿塞那平、卡马西平、卡利拉嗪、氟哌啶醇、锂、奥氮平、帕潘立酮、喹硫平、利培酮、他莫昔芬、丙戊酸和齐拉西酮的治疗反应优于治疗反应（ N = 56， n = 14503）；阿立哌唑、奥氮平、喹硫平和利培酮的全因停药率较低；然而，托吡酯的全因停药率较高（ N = 70， n = 16324）。 与安慰剂相比，阿立哌唑、阿塞那平、卡马西平、卡利拉嗪、氟哌啶醇、锂、奥氮平、帕潘立酮、喹硫平、利培酮、他莫昔芬、丙戊酸盐和齐拉西酮对躁狂症状的改善效果优于（ N = 61， n = 15466），阿立哌唑，阿塞那平、卡马西平、卡利拉嗪、氟哌啶醇、锂、奥氮平、帕潘立酮、喹硫平、利培酮、丙戊酸和齐拉西酮因无效而停药的比例较低（ N = 50， n = 14284）。总之，这些抗精神病药物、卡马西平、锂、他莫昔芬和丙戊酸盐对急性躁狂症有效。然而，只有阿立哌唑、奥氮平、喹硫平和利培酮比安慰剂具有更好的可接受性。