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CHI TIẾT
Tổng quan về hiệu quả và độ an toàn của chế độ liều olanzapin trong điều trị bệnh tâm thần phân liệt
Efficacy and safety of olanzapine at various dose levels for schizophrenia: A systematic review
Kiều Mai Anh, Cấn Khánh Linh, Nguyễn Thành Hải
Số: 528 - Tháng 4/2020 - Trang 3-9

Olanzapin là một thuốc chống loạn thần thế hệ 2, được sử dụng phổ biến với chỉ định điều trị tâm thần phân liệt (TTPL), tâm thần hưng cảm và bệnh lưỡng cực. Thuốc có phổ tác dụng rộng trên các triệu chứng nhận thức âm tính, dương tính của bệnh TTPL. Sử dụng olanzapin liều 5 - 20 mg/ngày được khuyến cáo trong thực hành lâm sàng thường qui song nồng độ thuốc thay đổi nhiều giữa các bệnh nhân và một số bệnh nhân có thể không cho đáp ứng hoặc đáp ứng không đầy đủ. Phân tích gộp của David J. M.CS. năm 2003 chỉ ra sự phụ thuộc tuyến tính giữa giảm điểm BPRS với logarit liều dùng của olanzapin trong khoảng 6,6 đến 16,3 mg/ngày. Điều này gợi ý rằng hiệu quả còn có thể tăng lên khi liều olanzapin vượt trên mức 16,3 mg/ngày. Trong khi các nghiên cứu khác cho liều cao olanzapin (>20 mg/ngày) trên bệnh nhân TTPL đã được thực hiện rất sớm từ những năm 1998 - 2001 và kết quả khác nhau nhiều giữa các nghiên cứu: Nghiên cứu của Pakpoor và CS. năm 2014 chỉ ra rằng hiệu quả và biến cố bất lợi của thuốc olanzapin phụ thuộc vào liều. Tuy nhiên, Kinon B. J.CS. lại chỉ ra sự khác nhau không có ý nghĩa về hiệu quả giảm điểm lâm sàng trung bình giữa các nhóm liều 40 mg/ngày, 20 mg/ngày và 10 mg/ngày (p = 0,295), còn tác dụng tăng cân, tăng triglycerid, tăng prolactin lại cao hơn có ý nghĩa ở nhóm liều cao (p < 0,001). Chính vì vậy, nghiên cứu này được thực hiện nhằm tổng quan hệ thống về hiệu quả và độ an toàn của các chế độ liều olanzapin trong điều trị TTPL.

Đối tượng

Các bài báo nghiên cứu được tìm kiếm trên các nguồn dữ liệu: Pubmed và The Cochrane Library. Lựa chọn các bài báo tính đến ngày 01/08/2019.

Phương pháp nghiên cứu

- Chiến lược tìm kiếm: Nguồn cơ sở dữ liệu tìm kiếm là Pubmed và The Cochrane Library. Việc tìm kiếm không giới hạn về thời gian công bố của các bài báo nghiên cứu và kết thúc vào ngày 01/08/2019. Cú pháp tìm kiếm bằng các từ khóa “olanzapine”

- Phương pháp xử lý số liệu: Phn mm Endnote X5.0.1 và phần mềm Excel.

Kết luận

Hiệu quả và độ an toàn của chế độ liều khuyến cáo của olanzapin đã được nghiên cứu khá đầy đủ. Bên cạnh đó, các nghiên cứu về liều cao vẫn đang hạn chế về số lượng, cỡ mẫu, thiết kế nghiên cứu, nên vẫn chưa khẳng định được hiệu quả và độ an toàn của mức liều này.

Olanzapine is an atypical antipsychotic widely prescribed for schizophrenia due to its own wide spectrum effect on possitive, negative and cognitive symptoms of the disease, The high-dose olanzapine had been used for higher efficience, and its prescribtion is increasing at National Psychiatry  Hospital (of Vietnam). This systematic review was focused on the drug efficacy and safety at various dose levels based on PUBMED and THE COCHRANE LIBRARY databases. 557 citations were identified, of which the final analysis  involved 29 randomized, double-blind and placebo-controlled trials at normal dose and 15 designs at high-dose. The efficacy and safety of the licensed dose of olanzapine had been generously studied worldwide, except for the Asean patient population. In general, such high-dose of olanzapine is not automatically applicable to any population, especially to the Vietnamese. However, there appeared a trend that the drug efficacy maybe positive in linearity with dose in the range of 5 to 15 mg/day, yet unclear for the higher dose. The safety had not been quite ensured for the high dose, especially for cardiovascular effects. Weight gain is the most researched adverse event, but unavailable are reports comparing the high dose and normal dose of olanzapine for adults.

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