抗雄激素药物治疗强迫症：系统评价,Current Medicinal Chemistry

目的：本研究旨在系统性地研究与强迫症患者相比，与安慰剂或常规护理相比，抗雄激素药物是否可以显着减轻强迫症（OCD）症状。

方法：截至2018年10月，使用相关关键字搜索PubMed，EMBASE，CENTRAL和国际临床试验注册平台（ICTRP）数据库。包括对包括强迫症患者在内的强迫症患者进行的所有随机且非随机的非随机研究，这些患者报告了其症状的变化。排除强迫性性欲研究。所需数据是由两名独立作者从所收文章的全文中提取的。发现一项随机试验和四项非随机试验。

结果：唯一的随机试验表明，与安慰剂相比，抗雄激素药物氟他胺可有效降低男性合并性Tourette综合征强迫症患者的强迫评分。四分之三的非随机试验表明，包括非那雄胺，醋酸环丙孕酮和曲普瑞林在内的不同抗雄激素类药物均可有效减轻OCD症状。唯一的研究未能显示出抗雄激素药的功效，该研究给OCD患者服用了氟他胺。尽管取得了积极的结果，但现有的研究基于推荐，评估，发展和评估工作组（GRADE）方法的等级提供了低质量的证据。

结论：可用的研究不足以精确回答我们的研究问题。仍然需要进一步的大型随机盲临床试验来评估抗雄激素在强迫症患者中的有效性。建议在设计研究和解释其结果时应考虑性别，合并症和耶鲁-布朗强迫症评分表（Y-BOCS）。

"点击查看英文标题和摘要"

Objective: This study aimed to systematically investigate whether anti-androgens could significantly reduce Obsessive-Compulsive Disorder (OCD) symptoms compared to placebo or usual care in OCD patients.

Methods: PubMed, EMBASE, CENTRAL and International Clinical Trials Registry Platform (ICTRP) databases were searched up to October 2018 using relevant keywords. All randomized and if not available non-randomized studies conducted on a population including OCD patients who were administered with anti-androgen, which reported changes in their symptoms, were included. The studies on compulsive hypersexuality were excluded. Required data were extracted from full-text of the included articles by two independent authors. One randomized and four non-randomized trials were found.

Results: The only randomized trial showed that flutamide, an anti-androgen agent, was effective in reducing compulsion scores in male OCD patients with comorbid Tourette syndrome, compared to placebo. Three out of four non-randomized trials showed that different anti-androgens including finasteride, cyproterone acetate and triptorelin were effective in reducing OCD symptoms. The only study, which failed to show the efficacy of an anti-androgen agent, administered OCD patients with flutamide. Despite the positive results, available studies provide the evidence with low quality based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach.

Conclusion: Available studies are not sufficient for a precise answer to our study question. There is still a need for further large randomized blinded clinical trials to evaluate the effectiveness of antiandrogens in OCD patients. It is recommended that gender, comorbidities and subscales of Yale- Brown Obsessive-Compulsive Score (Y-BOCS) should be considered in designing the studies and interpreting their results.