Olanzapine plus fluoxetine for bipolar disorder: A systematic review and meta-analysis
Olanzapine plus fluoxetine for bipolar disorder: A systematic review and meta-analysis
Data
2013
Autores
Silva, Marcus T.
Zimmermann, Ivan R.
Galvão, Tais F.
Pereira, Mauricio G.
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Affective Disorders
Resumo
Background: Olanzapine plus fluoxetine combination (OFC) is one of the current approaches for treating
the depressive phase of bipolar disorder. Our objective was to synthesize the evidence on the efficacy of
OFC therapy in bipolar depressed patients.
Methods: We searched for randomized controlled trials (RCTs) on MEDLINE, Embase and other
databases. Independent researchers selected the studies and extracted the data. The GRADE approach
was used to assess the quality of the evidence. The Mantel–Haenszel random effect model was used to
perform the meta-analyses.
Results: From 627 unique records retrieved, four RCTs were included (1330 patients). OFC improved the
response compared to olanzapine (relative risk [RR]1⁄41.58; 95% confidence interval [95% CI]: 1.27, 1.97)
and to placebo (RR1⁄41.99; 95% CI: 1.49, 2.65) but not to lamotrigine (low-quality evidence). Similar
results were found for remission and relapse rates. No differences were identified for levels of
depression and mania symptoms (low-quality evidence) and incidence of mania (moderate-quality
evidence). Adverse effects were more common in patients treated with OFC than in those treated with
lamotrigine (RR1⁄41.13; 95% CI: 1.04, 1.23), but no difference was found relative to the patients treated
with olanzapine (low-quality evidence).
Limitations: Despite the totality of the evidence included, there are few RCTs available regarding the
efficacy of OFC therapy for bipolar depression. The risk of attrition and reporting bias is also a concern.
Conclusions: OFC therapy improved the response, remission, and relapse rates among other outcomes.
However, a worse profile of adverse reactions was observed in some comparisons. These data clarify the
therapeutic use of OFC as an option to olanzapine in bipolar depression. The quality of the evidence
could be improved by additional comparisons and higher rates of treatment adherence.
Description
Palavras-chave
Bipolar disorder, Depression, Olanzapine–fluoxetine combination, Meta-analysis
Citação
Silva MT, Zimmermann IR, Galvao TF, Pereira MG. Olanzapine plus fluoxetine for bipolar disorder: a systematic review and meta-analysis. J Affect Disord. 2013 Apr 25;146(3):310-8. doi: 10.1016/j.jad.2012.11.001.