临床治愈 - 怡诺思.ppt

抑郁症的单胺假说：脑内单胺类递质减少，突触后膜受体上调。 * 文拉法辛对五羟色胺和去甲肾上腺素均有再摄取抑制作用，增加突触间隙递质浓度，从而改善相应的临床症状。 文拉法辛的双通道作用正是解决临床上因5-HT和NE功能异常而产生的抑郁焦虑的最佳方案。 * 抑郁症的症状有的与5-HT有关如食欲降低；有的与5-HT、NE、 DA都有关，比如抑郁情绪等，有的与NE、 DA有关，因此抑郁症的治疗与这3个递质系统都有关系，因此作用于这3个受体的药物，才会改善抑郁症的所有症状，文拉法辛对3条通路的作用机制解释了其作用强的原因。 * * 而M Thase的一个多达2045例患者的荟萃分析结果显示，怡诺思的8周临床治愈率比SSRI高1/3。而且临床治愈率的差异在治疗第二周就已经显著高于SSRI，并持续至第四、六、八周。SSRI包括氟西汀，帕罗西汀和氟伏沙明。怡诺思与SSRI相比的优势比为1.5。即对人群来说，怡诺思SSRI使多1/3的患者获得临床治愈；而对个体而言，服用怡诺思可以比服用SSRI多50%的机会获得临床治愈。（该荟萃分析采用了最严格的统计学方法：病例结转分析和意向分析）。 Thase ME, Entsuah AR, Rudolph RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001; 178: 234-241. 从这张图可以更直观的看到，怡诺思治疗第二周的临床治愈率就显著高于SSRI，而第八周时怡诺思的这种优势已经特别显著：高出1/3。 * Results of this analysis confirm the results of the previous pooled analysis of registration trials by Thase and colleagues demonstrating that more patients achieved remission of symptoms with venlafaxine/venlafaxine XR compared with the studied SSRIs. Overall remission rates at 8 weeks of treatment in a pooled analysis of 32 of 33 available studies (1 study was excluded from this analysis because the HAM-D scale was not used) were: venlafaxine/venlafaxine XR, 41% (1,364/3,300); SSRIs, 35% (1,121/3,236); and placebo, 24% (225/927). The venlafaxine-SSRI, venlafaxine-placebo, and SSRI-placebo comparisons at end point were all statistically significant (P0.001). These results confirm prior data suggesting the significantly greater likelihood of achieving remission of depression with a dual reuptake inhibitor such as venlafaxine/venlafaxine XR vs. the single-action SSRIs. Pooling of this entire dataset negates a common criticism of the original pooled analysis (i.e., that the 8 studies were “cherry-picked” or not representative of the entire dataset). This dataset included studies that met the rigid criteria required for registration studies as well as smaller postmarketing studies that did not necessarily meet these criteria. The fact that these data clo