Comparative efficacy and acceptability of neuromodulation procedures in the treatment of treatment-resistant depression: a network meta-analysis of randomized controlled trials

作者：Hao Li, Liqian Cui, Jinbiao Li, Yueheng Liu, Yue Chen · 发表于：Journal of Affective Disorders · 年份：2021 · DOI：10.1016/j.jad.2021.03.019 · 被引用次数：120 · 研究领域：Transcranial Magnetic Stimulation Studies、Neurological disorders and treatments、Pain Management and Treatment

BACKGROUND: Nearly half of the patients with depression experience suboptimal benefits from antidepressants. Neuromodulation therapies, a kind of technology that can regulate neuronal firing activity by electrical or magnetic stimulation, were introduced to improve this situation. However, the results from clinical trials have been inconsistent. METHODS: We followed the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to perform this network meta-analysis (NMA). The results were evaluated by relative risk (RR) for the response, remission, and discontinuation rates. RESULTS: In total, 49 trials with 2,941 patients were included in this study. Bilateral theta burst stimulation (TBS, RR 5.00, 95% CI 1.11-22.44), priming transcranial magnetic stimulation (pTMS, RR 2.97, 95% CI 1.20-7.39), low-frequency right repetitive transcranial magnetic stimulation (TMS) (LFR-rTMS, RR 2.62, 95% CI 1.56-4.39), high-frequency left repetitive TMS (HFL-rTMS, RR 2.18, 95% CI 1.52-3.13), and bilateral repetitive TMS (BL-rTMS, RR 3.08, 95% CI 1.78-5.31) were demonstrated to have higher response rates than sham control. BL-rTMS (RR 3.12, 95% CI 1.06-9.09) was found to have a higher response rate than deep brain stimulation in this NMA. All measures had the non-inferiority acceptability than the sham-control. BL-rTMS was more acceptable than bitemporal ECT (BT-ECT, RR 0.18, 95% CI 0.03-0.89), while pTMS was more acceptable than BT-ECT (RR 0.08, 95%...