癌因性疲憊的藥物治療：系統性回顧與整合分析方法

Pharmacotherapy of Cancer-related Fatigue: a Systematic Review and Meta-Analysis

郭文瑩(Wen-Ying Kuo)

指導教授 ： 吳建德

共同指導教授 ： 賴允亮

臺北醫學大學/藥學院/藥學院生技製藥產業碩士專班/碩士(2013年)

https://doi.org/10.6831/TMU.2013.00052

摘要

癌因性疲憊 (cancer-related fatigue) 為癌症或癌症治療中常見的副作用之一，具較高的盛行率且會影響病人整體的生活品質。然而目前仍未有以癌因性疲憊做為主要適應症並經美國食品藥物管理局核准的藥物，其實際臨床治療效果仍處於試驗階段。
本研究目的為藉搜尋目前已發表之癌因性疲憊藥物研究文獻，整理歸納後對藥物之臨床療效及安全性做進一步探討，以期望得到更好之藥物治療使用依據。我們搜尋Pubmed、Cochrane Library及Scopus資料庫，搜尋條件為2013年3月1日前發表之臨床研究文獻，文獻經篩選後進行全文評讀並以Jadad量表及牛津大學證據等級量表評分，另外若同類藥物研究符合整合分析標準將進一步以Revman軟體進行分析。
合格的文獻共58篇，研究藥物包括psychostimuants、抗憂鬱劑、donepezil、類固醇藥物、紅血球生成刺激劑、L-carnitine、TRH及生藥中草藥製劑 (包括guarana、人參、PG2、參附注射液及天仙液-P)。Psychostimulants類中之methylphenidate有較多之研究證明其使用效果，且其整合分析結果顯示與安慰劑比起具顯著療效 (P值= 0.003)。而紅血球刺激劑多數研究顯示有顯著效果，但本研究之整合分析結果則顯示其療效與安慰劑比起無顯著差異 (P值= 0.88)。modafinil、bupropion、類固醇藥物、TRH、guarana、補中益氣湯、西洋參、PG2、參附注射液及天仙液-P在研究上顯示有顯著療效，但臨床證據較少，需仰賴更多質量較高的研究結果證實；paroxetine、sertraline、dexamphetamine及L-carnitine則是有品質較高的研究證據證實無顯著療效。
由分析資料顯示，methylphenidate有較多研究證據可證明其療效；而紅血球生成刺激劑雖有多數研究證實其有效，但本研究之整合分析結果則未顯示有顯著療效；至於其他藥物的臨床療效研究證據仍不足，故期望未來有更多相關研究結果發表，才可再次評估其使用療效。

關鍵字

癌因性疲憊 ； 藥物治療 ； 系統性回顧 ； 整合分析

並列摘要

Cancer-related fatigue (CRF) is the most common symptom of cancer and its treatment. This symptom is highly prevalent and may decrease patients’ quality of life. Nevertheless, in recent pharmacologic treatment, there are no medicines that are approved by FDA for this specific symptom yet, and the treatments are still in experimental process.
In this paper, the effectiveness and safety of the medicine for CFR are being discussed and analyzed based from several published research reports. We researched and appraised the articles which had been published before March 2013 from the Pubmed, Cochrane library and Scopus. In addition, we conducted the Jadad Scale and CEBM Levels of Evidence. The meta-analysis were used when the studies meet the criteria.
From our research, there were 58 eligible articles that meet our criteria. The classification of the medicines include psycostimulants, antidepressants, donepezil, L-carnitine, erythropoiesis-stimulating agents (ESAs), TRH and CAM (guarana, ginseng, PG-2, SF injection, THL-P). Methylphenidate is one type of psychostimulants, and we have found several well-designed studies to support the clinical use, furthermore, our meta-analysis’ results have shown that there is a significant improvement compared to placebo (P-value = 0.003). There are many studies that have proven that ESAs’ positive results. But in our meta-analysis results, it didn’t show the significant effectiveness (P-value = 0.88). In modafinil, bupropion, steroids, TRH and CAM, although there had positive result about clinical use, but only few studies can support this result. In paroxetine, sertraline, dexamphetamine, and L-carnitine had well-designed studies to show it were no better than placebo in the treatment of CRF.
In our research, methylphenidate may be the ideal medical choice for managing CRF. Although we have found several research reports that have shown positive results for the usage of ESAs, but in our meta-analysis, the result did not show the significant difference with placebo. However, further experiments still need to be implemented to determine the actual safety and effectiveness of some particular medicines for CRF.

並列關鍵字

cancer-related fatigue ； pharmacotherapy ； systematic review ； meta-analysis

參考文獻

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