Efficacy and safety of rTMS combined with agomelatine in the treatment of depression:a Meta-analysis and trial sequential analysis
10.12173/j.issn.1005-0698.202407033
- VernacularTitle:重复经颅磁刺激联合阿戈美拉汀治疗抑郁症有效性与安全性的Meta分析与试验序贯分析
- Author:
Ruihuan ZHANG
1
;
Yaofeng YANG
;
Tao HAO
;
Jun CHEN
Author Information
1. 榆林市中医医院脑病科(陕西榆林 719000)
- Keywords:
Agomelatine;
Repetitive transcranial magnetic stimulation;
Depression;
Meta-analysis;
GRADE evidence;
Trial sequential analysis;
Randomized controlled trial
- From:
Chinese Journal of Pharmacoepidemiology
2024;33(10):1124-1136
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically review the efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)combined with agomelatine in the treatment of depression.Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,VIP,WanFang Data,SinoMed and Yiigle databases were electronically searched to collect randomized controlled trials(RCTs)of comparison between rTMS combined with agomelatine(combined group)and agomelatine or combined pseudostimulation(control group)in the treatment of depression from inception to May 10,2024.Meta-analysis was performed by using RevMan 5.4 software,GRADE grading system for evaluating the level of evidence for observational indicators,and TSA 0.9.5.lBeta software for trial sequential analysis.Results A total of 15 RCTs involving 1 196 patients were included.Meta-analysis showed that compared with control group,combination group had a higher effective rate(RR=1.24,95％CI 1.15 to 1.34,P＜0.001),lower depression scale score(SMD=-2.95,95％CI-3.71 to-2.19,P＜0.001),anxiety scale score(SMD=-2.21,95％CI-3.29 to-1.14,P＜0.001),PSQI score(MD=-1.69,95％CI-2.79 to-0.59,P=0.003).There was no statistical difference between the two groups in terms of NE level,5-HT level and incidence of adverse reactions(P＞0.05).GRADE quality grading of the evidence showed moderate-quality evidence for the effectiveness rate and incidence of adverse reactions,with the depression scale score and the NE level of the evidence being low-quality,and the level of evidence for the anxiety scale score,the PSQI score,and the 5-HT content was very low.The trial sequential analysis results showed that in terms of effective rate,the analysis results of combination group superior to control group were reliable,and the conclusion could exclude false positives.Conclusion The rTMS combined with agomelatine in the treatment of depression has advantages in improving effective rate,depression scale score,anxiety scale score and PSQI score compared with agomelatine alone or combined pseudostimulation,incidence of adverse reactions were equivalent to those of agomelatine aloneor or combined pseudostimulation.
