Effektivität einer Augmentationstherapie mit Antipsychotika bei therapieresistenten Zwangsstörungen – eine Metaanalyse doppelblinder, randomisierter, placebokontrollierter Studien

Zusammenfassung

Da bei der Zwangsstörung nur etwa 40 – 60 % aller Patienten auf Serotonin-Wiederaufnahmehemmer (SRIs) ansprechen, kommt der Evaluation additiver Therapien bei Behandlungsresistenz eine hohe klinische Relevanz zu. Mittels systematischer Literaturrecherche wurden alle doppelblinden, randomisierten, placebokontrollierten Studien erfasst, die die Wirksamkeit einer SRI-Antipsychotika-Kombinationstherapie bei therapieresistenten Zwangsstörungen evaluiert haben. 11 Studien mit insgesamt 356 Teilnehmern wurden identifiziert. Nach der Augmentationsbehandlung erfüllten in den Interventionsgruppen (SRI + Antipsychotikum) signifikant mehr Probanden das Responder-Kriterium (Reduktion im Yale-Brown Obsessive Compulsive Scale [Y-BOCS] ≥ 35 %) als in den Kontrollgruppen (SRI + Placebo) (relatives Risiko = 2,16). Die Subgruppenanalyse zeigte nur für Risperidon eine signifikante Effektivität. Weitere signifikante Unterschiede fanden sich hinsichtlich der Dosierung der Antipsychotika und der Dauer der SRI-Medikation vor der Augmentationsphase.

Abstract

Only 40 – 60 % of all patients with obsessive-compulsive disorder (OCD) respond to serotonin reuptake inhibitors (SRIs). Therefore, the evaluation of additive treatment in the presence of treatment resistance has high clinical relevance. All double-blind, randomised, placebo-controlled trials that evaluated the efficacy of a combination therapy of SRIs and antipsychotics in treatment-resistant OCD were identified by systematic literature searches and combined in a meta-analysis. 11 studies with a total of 356 treatment-resistant patients were included. After the augmentation, significantly more subjects in the intervention groups (SRI + antipsychotic) fulfilled the response criterion (reduction in the Yale-Brown obsessive compulsive scale [Y-BOCS] ≥ 35 %) than in the control groups (SRI + placebo) (relative risk = 2.16). The subgroup analysis showed significant efficacy only for risperidone. Further significant differences have been found regarding the antipsychotic dosage and the SRI-treatment duration before the augmentation.

Zwangsstörung - Antipsychotika - Serotonin-Wiederaufnahmehemmer - Therapieresistenz - Metaanalyse

obsessive-compulsive disorder - antipsychotics - serotonin reuptake inhibitors - treatment resistance - meta-analysis

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