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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Systematic review and meta-analysis of rates of clozapine-associated myocarditis and cardiomyopathy
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Systematic review and meta-analysis of rates of clozapine-associated myocarditis and cardiomyopathy

机译：系统评价和氯氮平相关的心肌炎和心肌病的率的荟萃分析

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Background: Clozapine is the most effective medication for treatment refractory schizophrenia, but is associated with cardiac adverse drug reactions. Myocarditis and cardiomyopathy are the most serious cardiac adverse drug reactions although reported rates of these conditions vary in the literature. We systematically reviewed and meta-analysed the event rates, the absolute death rates and case fatality rates of myocarditis and cardiomyopathy associated with clozapine. Methods: PubMed, EMBASE and PsycINFO were searched for studies that reported on the incidence of cardiomyopathy or myocarditis in people exposed to clozapine. Data were meta-analysed using a random effects model, with subgroup analysis on study size, time frame, region, quality, retrospective vs prospective, and diagnostic criteria of myocarditis or cardiomyopathy. Results: 28 studies of 258,961 people exposed to clozapine were included. The event rate of myocarditis was 0.007 (95% confidence interval [CI] = [0.003, 0.016]), absolute death rate was 0.0004 (95% CI = [0.0002, 0.0009]) and case fatality rate was 0.127 (95% CI = [0.034, 0.377]). The cardiomyopathy event rate was 0.006 (95% CI = [0.002, 0.023]), absolute death rate was 0.0003 (95% CI = [0.0001, 0.0012]) and case fatality rate was 0.078 (95% CI = [0.018, 0.285]). Few included studies provided information on criteria for diagnosis of myocarditis and cardiomyopathy. Event rates of cardiomyopathy and myocarditis were higher in Australia. Conclusion: Clarity of diagnostic criteria for myocarditis remains a challenge. Observation bias may, in part, influence higher reported rates in Australia. Monitoring for myocarditis is warranted in the first 4 weeks, and treatment of comorbid metabolic syndrome and diabetes may reduce the risk of cardiomyopathy. The risks of myocarditis and cardiomyopathy are low and should not present a barrier to people with treatment refractory schizophrenia being offered a monitored trial of clozapine.
机译：背景：氯氮平是治疗难治性精神分裂症的最有效的药物，但与心脏不良药物有关。 Myocardis和心肌病是最严重的心脏不良药物反应，尽管这些条件的率在文献中有所不同。我们系统地审查和荟萃分析了事件率，绝对死亡率和心肌炎和与氯氮平相关的心肌病的病例率。方法：搜查了PubMed，Embase和Psycinfo，用于研究暴露于氯氮平的人们心肌病或心肌炎的发生率。数据使用随机效应模型进行了荟萃分析，具有关于研究规模，时间框架，区域，质量，回顾性的亚组分析，以及心肌炎或心肌病的诊断标准。结果：28项研究了258,961人暴露于氯氮平的人。心肌炎的事件率为0.007（95％置信区间[CI] = [0.003,0.016]），绝对死亡率为0.0004（95％CI = [0.0002,0.0009]）和病例率为0.127（95％CI = [0.034,0.377]）。心肌病事件率为0.006（95％CI = [0.002,0.023]），绝对死亡率为0.0003（95％CI = [0.0001,0.0012]）和病例率为0.078（95％CI = [0.018,0.285] ）。很少有研究提供了有关诊断心肌炎和心肌病的标准的信息。澳大利亚的心肌病和心肌炎的事件率较高。结论：心肌炎诊断标准的清晰度仍然是一项挑战。部分偏见可能部分地影响澳大利亚的报告率较高。在前4周内有保证心肌炎的监测，并治疗合并代谢综合征和糖尿病的治疗可能会降低心肌病的风险。心肌炎和心肌病的风险低，不应该向治疗难治性精神分裂症的人提出障碍的障碍，所以正在提供监测的氯氮平试验。

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