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Instituto Nacional de Neurología y Neurocirugía

2015, Número 1

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Arch Neurocien 2015; 20 (1)


La combinación olanzapina/fluoxetina como tratamiento para la depresión resistente al tratamiento: una revisión sistemática

Tamayo JM, Pica-Ruiz Y, Ruiz I

Idioma: Ingles.
Referencias bibliográficas: 52
Paginas: 3-19
Archivo PDF: 192.14 Kb.


RESUMEN

Objetivo: se realizó una revisión sistemática para evaluar la evidencia de la eficacia y seguridad de la combinación olanzapina/fluoxetina (COF) en pacientes con depresión resistente al tratamiento (DRT). Material y métodos: se realizaron búsquedas a través de MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, y LillyTrials.com (28 de febrero de 2014) utilizando términos relacionados con DRT y COF (restricciones de idioma). Todos los estudios prospectivos de tratamiento con COF en DRT fueron incluidos. Resultados: se incluyeron 16 estudios (5 metaanálisis, 3 análisis agrupados, 7 ensayos controlados aleatorios [ECA], y un estudio abierto no aleatorizado); los datos no publicados de la extensión abierta estuvieron disponibles para 4 ECA. La definición de DRT varió; la mayoría de los estudios definieron DRT como una respuesta insuficiente después de 2 ensayos con antidepresivos de ≥4 semanas. Todos los ECA compararon COF con fluoxetina. En los ECA, la duración del tratamiento fue de 4 a 12 semanas, y de 8 a 76 semanas en los estudios abiertos. Los síntomas depresivos mejoraron con el tratamiento de COF en todos los estudios; la mejoría fue; por lo general, mayor y ocurrió más temprano que con fluoxetina y se mantuvo durante el tratamiento a largo plazo. Las tasas de respuesta (27.5 a 80%) y remisión (16.9 a 73.3%) fueron; por lo general, mayores que con fluoxetina. La ganancia de peso y cambios en los parámetros metabólicos fueron por lo general más comunes en pacientes tratados con COF que con fluoxetina. Otros eventos adversos y las tasas de discontinuación fueron similares a los observados con fluoxetina. Conclusiones: la evidencia de estudios prospectivos apoya la eficacia de COF en el tratamiento de DRT, la cual se mantiene con el tratamiento a largo plazo. Sin embargo, puede existir un riesgo mayor de ganancia de peso y cambios en los parámetros metabólicos. Los médicos pueden considerar COF como un tratamiento para DRT, siempre que los riesgos de ganancia de peso y cambios metabólicos sean activamente manejados.


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