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                您當前位置:網站首頁 >> 醫藥新聞 >> 行業動態 >> 帶你認識第一款專門治療產后抑郁癥的藥物
               
               
              帶你認識第一款專門治療產后抑郁癥的藥物
              2019-03-21 10:55:41 來源:丁香園 瀏覽:3171

              繼 3 月 5 日美國 FDA 批準艾氯胺酮用于治療難治性抑郁癥后,在 3 月 19 號又批準了一種新型抗抑郁藥物。但與以往不同的是,這個藥物是專門用于治療產后抑郁癥的。

              時間緊的讀者,可以快速預覽以下關鍵信息:

              • 安全性:該藥物對嬰兒安全,主要成分為四氫孕酮,很少經過乳汁分泌。

              • 給藥方式:該藥物為注射液,需要連續靜脈注射 60 個小時(約 2.5 天)。

              • 副作用:存在過度鎮靜和意識突然喪失的風險,需要在有資質的機構接受治療,并要隨時監測患者的血氧水平。

              • 價格:價格超級昂貴,不包含住院費在內,費用高達 2 萬美元!

              • 療效:快速起效,1-2 天就能顯著緩解抑郁癥狀,并能持續 1 個月以上。

              若您有時間,為了跟隨最新的潮流,全面了解這個藥物,請大家跟隨【精神時間】來一起認識這個新藥。

              1. 什么是產后抑郁癥?

              大約有 50%-80% 的產婦會經歷產后抑郁,而 10%-20% 的產婦會進展為產后抑郁癥。產后抑郁癥是孕婦分娩后最常見的一種精神疾病,通常在分娩后 4 周內起病,其診斷所需要的癥狀和病程標準和其他抑郁癥類似。

              但由于發生在產后這一特殊時期,患有產后抑郁癥的婦女,其情緒、認知、行為和功能受到顯著地影響,無法很好地照顧自己的嬰兒。

              此外,產后抑郁癥患者出現自殺意念和自殺行為的比例較高。最可怕的是,一些深陷產后抑郁的患者,看不到自己活下來的意義,有著強烈的自殺意念,并固執地認為自己死了孩子得不到很好的照顧,與其留她/他活在世上受罪,還不如也一起帶走她/他。這類產后抑郁癥導致的擴大性自殺事件比比皆是,這種人間慘劇天天都在上演。

              2. 產后抑郁癥一般怎么治?

              對于一些病情較輕的產后抑郁癥,一般選擇心理治療,如人際心理治療、認知行為療法和家庭治療等。對于一些病情較重的患者,目前將 SSRIs 類的藥物作為首選。一般而言,抗抑郁藥物在乳汁中的濃度較低。但需要除外氟西汀,氟西汀能夠通過乳汁進行分泌。

              需要注意的是一般的抗抑郁藥物通常需要 2-4 周才能起效。在臨床上最讓醫生頭痛的,就是患者擔憂吃藥可能會影響嬰兒,選擇自己一個人硬扛著,導致病情進一步進展。

              3. Zulresso 是一種什么藥物?

              Zulresso 是一種注射液,最近剛剛被美國 FDA 批準,專門用于治療產后抑郁癥。在此之前,還沒有任何一種藥物或注射劑,來專門用于治療產后抑郁癥。

              從藥理學的角度來看,Zulresso 是一種 GABAA 受體的變構調節劑,能夠激活突觸內外的 GABAA 受體,并產生抗抑郁和抗焦慮作用。

              Zulresso 的主要成分為四氫孕酮(Allopregnanolone),四氫孕酮能夠和 GABAA 受體相結合,從而增加該受體上氯離子通道的開放頻率,降低神經興奮性等,能夠抑制 HPA 軸亢進以及促進神經發生。

              4. 為什么 Zulresso 要注射才能使用?

              從上文可知,Zulresso 主要為四氫孕酮,而四氫孕酮是一種神經類固醇,親脂性強,但水溶性差。此外,四氫孕酮口服生物利用度差,會被快速代謝掉。

              因此,針對以上問題,藥廠開發出了注射劑。通過緩慢且持續的給藥,能夠產生穩定的血藥濃度,并產生治療作用。

              5. 為什么要住院接受治療?

              首先,該藥物需要持續注射 60 個小時,耗時較長;其次,注射該藥可能存在過度鎮靜和意識突然喪失等副作用,需要在醫院里面進行觀察,并隨時監測其血氧水平。所以主要考慮到其副作用和注射方式,住院治療是最穩妥的方式。

              此外,FDA 要求生產商對該藥進行風險評估和緩解策略(Risk Evaluation and Mitigation Strategy,REMS)管理,以確保各處方藥和生物制品的收益大于風險。同樣地,前段時間批準的艾氯胺酮也要接受 REMS 的管理,在監督的情況下合理地使用這些藥物。

              6. 效果如何??

              在 2017 年和 2018 年,The Lancet 雜志上陸續發表了 Zulresso 的 II 和 III 期臨床試驗結果。

              在 II 期臨床中,一共納入了 21 名產后抑郁癥的患者,按照 1:1 的比例分配患者接受 Zulresso 和安慰劑治療,并在開始注射后的多個時間點評估其抑郁癥狀。

              結果發現,在開始注射 1 天后,接受 Zulresso 治療的試驗組抑郁癥狀顯著降低,其效果能一直持續到 1 個月。

              1.png

              II 期試驗結果:發現 Zulresso 在注射后 1 天可顯著地降低患者的抑郁癥狀,效果還能持續 1 個月

              在 III 期試驗時,納入的樣本量更大,參與研究的中心更多,并將研究分為了兩部分來進行驗證結果。結果同樣一致地提示,Zulresso 能夠較快地緩解產后抑郁癥患者的抑郁癥狀。

              7. 有什么副作用?

              較為常見的副作用包括頭痛、頭暈、困倦、注射點疼痛、惡心、口干和疲勞感。因此,在接受 Zulresso 治療后,患者不能駕駛汽車和操作機械,也不能進行其他的危險行為,除非患者的倦意完全消退。

              當然了,并不是每一個人都能「享受」到 Zulresso 的副作用,前提是你得有錢才行。

              參考文獻

              1. FDA approves first treatment for post-partum depression. (2019).

              2. Kanes S, Colquhoun H, Gunduz-Bruce H, et al. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial[J]. The Lancet, 2017, 390(10093): 480-489.

              3. Meltzer-Brody S, Colquhoun H, Riesenberg R, et al. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials[J]. The Lancet, 2018, 392(10152): 1058-1070.

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