Olanzapine plus fluoxetine for bipolar disorder: a systematic review and
meta-analysis.
Author(s): Silva MT(1), Zimmermann IR, Galvao TF, Pereira MG.
Affiliation(s): Author information:
(1)University of Brasilia, Brasilia, DF 70904-970, Brazil.
Publication date & source: 2013, J Affect Disord. , 146(3):310-8
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]=1.58; 95% confidence interval [95% CI]: 1.27, 1.97) and to placebo (RR=1.99;
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 (RR=1.13; 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.
|