Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials

This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p2 = 62%), separating the two groups as early as weeks 1–2 with an SMD of -0.58 (p2 = 0%); (2) study-defined response (RR = 1.48, pTrial registrationCRD42014006689 (PROSPERO).本项针对随机对照试验（randomized controlled trials, RCTs）的荟萃分析，旨在比较电抽搐治疗（electroconvulsive therapy, ECT）联合非氯氮平类抗精神病药物，与单纯使用同种抗精神病药物治疗难治性精神分裂症（treatment-resistant schizophrenia, TRS）的疗效与安全性。由两名独立研究者提取数据，开展随机效应荟萃分析及预先设定的亚组、荟萃回归分析。本研究计算了加权均数差/标准化均数差（WMD/SMD）、风险比（RR）±95%置信区间（CI）、需治疗人数（NNT）及需伤害人数（NNH）。最终共纳入11项研究（总样本量n=818，平均研究时长10.2±5.5周）用于荟萃分析。结果显示，辅助ECT治疗在以下两方面均优于单纯抗精神病药物治疗：（1）末次随访终点的症状改善情况，标准化均数差为-0.67（p2=62%），两组差异早在第1~2周即显现，此时标准化均数差为-0.58（p2=0%）；（2）研究预设的应答率（RR=1.48）。本研究已完成试验注册，注册号为CRD42014006689（PROSPERO平台）。