La combinación olanzapina/fluoxetina como tratamiento para la depresión resistente al tratamiento: una revisió
2015
Objective: we conducted a systematic review to evaluate the evidence for the efficacy and safety of olanzapinefluoxetine combined (OFC) in patients with
treatment-resistant depression (TRD). Material and methods: MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, and LillyTrials.com were searched (28 February 2014) using terms related to
TRD and OFC (no language restrictions). All prospective studies of OFC treatment of TRD were included. Results: we included 16 studies (5 meta-analyses, 3 pooled analyses, 7 randomized
controlled trials [RCTs], 1 nonrandomized, open-label trial); unpublished data of open-label extensions were available for 4 RCTs. The definition of TRD varied; most studies defined TRD as
response failure after 2 antidepressant trials of4 weeks. All RCTs compared OFC with fluoxetine. Treatment duration was 4 12 weeks in RCTs, and 8 76 weeks in open-label studies. Depressive
symptoms improved with OFC treatment in all studies; improvement was generally greater and occurred earlier than with fluoxetine and was sustained during longer-term treatment. Response
(27.5%-80%) and remission (16.9%-73.3%) rates were generally greater than with fluoxetine. Weight gain and changes in metabolic parameters were generally more common in patients treated with
OFC than with fluoxetine. Other adverse events and discontinuation rates were similar to those seen with fluoxetine. Conclusions: evidence from prospective studies supports the efficacy of OFC
in the treatment of TRD, which is sustained with longer-term treatment. However, there may be a greater risk of weight gain and changes in metabolic parameters. Physicians may consider OFC as
treatment for TRD, provided the risks of weight gain and metabolic changes are actively managed.
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