| Objective:Lithium is a classical drug treatment option for bipolar disorder(BD)in maintenance phase,but some novel drugs(such as lurasidone,etc.)and combination therapy have also been evaluated for this indication.Mesh meta-analysis was used to evaluate and compare the effectiveness and acceptability of 20 maintenance phase drug treatment strategies for bipolar disorder.Methods:Pub Med,EMBASE,Psyc INFO and China journal net database(CNKI),Wan Fang data,service system of Chinese biomedical literature(Sino Med)database retrieval,retrieval on BD before November 21,2019 single drug or with drug therapy,randomized,double-blind controlled study,treatment effectiveness and acceptability of at least 12 weeks ending index number of participants are any recurrence of emotional events,as well as the number of participants for any event to suspend the work.In this study,Frequentists random-effects mesh meta-analysis was used to evaluate the effectiveness and acceptability of drug therapy in maintenance phase of BD.After literature screening and data extraction and quality evaluation were conducted by two researchers according to inclusion and exclusion criteria,data analysis was conducted by Stata 14.0 software.Results:42 studies were included,and 20 kinds of maintenance treatments for bipolar disorder were performed in 10431 patients.Participants assigned to all assessed treatments had a significantly lower risk of any mood relapse or recurrence compared with placebo,lurasidone(RR:0.40,95%CI 0.19-0.83)quetiapine(RR:0.50,0.33-0.74)olanzapine(RR:0.51,0.35-0.75).Lithium(RR:0.78,0.62-0.97)showed a statistically significant difference in efficacy compared to placebo.Quetiapine(RR:0.14,0.03-0.67),olanzapine(RR:0.15,0.02-0.92),aripiprazole + lamotrigine(RR:0.25,0.10-0.68),valproate(RR:0.38,0.23-0.60),lamotrigine + valproate(RR:0.40,0.21-0.74),ziprasidone(RR:0.41,0.18-0.92).The cumulative ranking curve and league table were used to show the effectiveness and acceptability.The results based on the area under the cumulative ranking curve(SUCRA)showed that the effectiveness of lurasidone was the best in the maintenance treatments of bipolar disorder.Acceptability of lithium + carbamazepine was the best by cluster analysis.Quetiapine,lurasidone and lithium + carbamazepine presented the best both in the effectiveness and in the acceptability.Conclusion:Most of maintenance treatment strategies were more effective than placebo,and are were general well tolerance,lurasidone should remain the first-line treatment when prescribing a relapse-prevention drug in patients with bipolar disorder,notwithstanding its acceptability profile.Clinicians should consider individual differences in drug sensitivity when making clinical decisions.Accumulating more high-quality studies of new drugs to intervene in the maintenance phase of BD will help to provide more objective evidence for clinical decision-making. |
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