Comparative Efficacy And Safety Of Antidepressant Therapy For The Agitation Of Dementia:A Systematic Review And Network Meta-analysis

Purpose:Dementia is a clinical syndrome commonly seen in the elder people.Agitation,as one of the more common neuropsychiatric symptoms,has a serious impact on the quality of life of people with dementia,and its incidence is increasing annually.Antidepressants have been shown to be effective in agitated patients with dementia,but there is no direct comparison between them.We carried out a network meta-analysis(NMA)to examine the efficacy and safety of these antidepressants.Materials and Methods:The study was searched in eight publicly available databases(Pub Med,Cochrane Library,Web of science,Embase,Wanfang database,China Knowledge Network,Vip and China Biomedical Literature Service),with a combination of subject and free word search fields,and with search dates from the date of database creation to 6 November2022.The search results did not limit the type of publication.Type of study: randomised controlled trial.Study population: patients with various types of dementia.Interventions: antidepressants in the trial group and antidepressants or placebo in the control group.Information extracted from the screening literature:(1)information on the source of literature and general characteristics of the included studies;(2)interventions;(3)duration of intervention;(4)outcome indicators.The quality of the included studies was evaluated using the risk of bias assessment tool recommended by the Cochrane 5.4 systematic evaluation handbook.The results of the Meta-analysis were presented using a network plot,and where heterogeneity existed,the sources of heterogeneity were analysed,and sensitivity analysis tests and subgroup analyses were performed when necessary.The results of the included literature were analysed using Stata 14.2 software based on the frequency method.The study was registered with PROSPERO and its registration number is CRD42022320932.Results:Twelve articles with 1,146 participants were included in our study.Based on the outcome of the agitation score,citalopram(standardized mean difference,SMD =-0.44,95% confidence interval,95%CI =-0.72 to-0.16)showed significant benefits over the placebo group.Based on the outcome of the total adverse events,Trazodone(odds ratio,OR = 4.58,95%CI = 1.12 to 18.69)had a higher risk than placebo.Conclusion:Among the antidepressants of included study,citalopram was probably the only optimal intervention,based on the improvement from baseline to the end of the intervention and no statistical difference compare with placebo in safety.