琥珀酸地文拉法辛治疗抑郁症剂量优化研究的网络meta分析OACHSSCD

Objective:To systematically evaluate the efficacy and safety of different dosing regimens of des-venlafaxine succinate(DVS)in treating major depressive disorder(MDD).Methods:PubMed,Embase,Web of Science,and Cochrane Library were searched to identify randomized controlled trials(RCTs)investigating DVS for the treatment of adult MDD.Both dose-range and fixed-dose analyses were performed.Outcomes included changes in the 17-item Hamilton Depression Rating Scale(HAMD-17),Montgomery-Asberg Depression Rating Scale(MADRS),and treatment-emergent adverse events(TEAEs).Bayesian random-effects models and Markov Chain Monte Carlo methods were applied for network meta-analysis and cumulative probability ranking.Publication bias was assessed using funnel plots.Data analyses were conducted using R 4.2.1 and Stata 16.0.Results:Fourteen RCTs(n=6 521)were included.Dose-range analysis indicated that 200-400 mg/day group achieved greater im-provement in HAMD-17(MD=-2.68,95%CI:-3.88--1.47)and MADRS(MD=-3.80,95%CI:-5.42--2.21)compared with other groups.The efficacy ranking was 200-400 mg/day＞100-200 mg/day＞0-100 mg/day.The incidence of TEAEs in this group did not differ significantly from placebo(P＞0.05).Fixed-dose analysis supported 200 mg/day as the optimal balance of efficacy and safety,showing the most significant im-provement in HAMD-17(MD=-2.38,95%CI:-3.82--0.85)and MADRS(MD=-3.78,95%CI:-5.65--1.92),with TEAEs comparable to placebo.Conclusion:The efficacy of DVS appears to follow a dose-dependent trend.Base on the current evidence,a fixed dose of 200 mg/d may represent a relatively favorable bal-ance between efficacy and safety,and may serve as a reference dose selection in clinical practice.