Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis

BMJ : British Medical Journal
J GeddesP Bebbington

Abstract

To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia. Systematic overview and meta-regression analyses of randomised controlled trials, as a basis for formal development of guidelines. 12 649 patients in 52 randomised trials comparing atypical antipsychotics (amisulpride, clozapine, olanzapine, quetiapine, risperidone, and sertindole) with conventional antipsychotics (usually haloperidol or chlorpromazine) or alternative atypical antipsychotics. Overall symptom scores. Rate of drop out (as a proxy for tolerability) and of side effects, notably extrapyramidal side effects. For both symptom reduction and drop out, there was substantial heterogeneity between the results of trials, including those evaluating the same atypical antipsychotic and comparator drugs. Meta-regression suggested that dose of conventional antipsychotic explained the heterogeneity. When the dose was </=12 mg/day of haloperidol (or equivalent), atypical antipsychotics had no benefits in terms of efficacy or overall tolerability, but they still caused fewer extrapyramidal side effects. There is no clear evidence that atypical antipsychotics are more effective or are better tolerated than conventio...Continue Reading

References

Apr 24, 2007·Neurotoxicity Research·Alan I Green
Aug 10, 2007·Der Nervenarzt·Wolfgang Maier, H-J Möller
Dec 30, 2004·Social Psychiatry and Psychiatric Epidemiology·Margherita AndrettaCorrado Barbui
Jul 22, 2008·Social Psychiatry and Psychiatric Epidemiology·Kok Yoon Chee
Feb 18, 2005·Psychopharmacology·Carmen Chung, Gary Remington
Jan 25, 2013·Psychopharmacology·Melanie D GuenetteGary J Remington
Aug 19, 2004·European Journal of Clinical Pharmacology·Lorenza MaglianoNational Mental Health Project Working Group
Jan 30, 2008·European Journal of Clinical Pharmacology·Silvio Garattini, Vittorio Bertele'
Dec 31, 2005·European Archives of Psychiatry and Clinical Neuroscience·Wolfgang Maier, Hans-Jürgen Möller
Nov 27, 2009·European Archives of Psychiatry and Clinical Neuroscience·Wolfgang Maier, Hans-Jürgen Möller
Oct 20, 2009·European Archives of Psychiatry and Clinical Neuroscience·Hans-Jürgen Möller, Wolfgang Maier
Feb 14, 2006·European Child & Adolescent Psychiatry·Jorge L Armenteros, Mark Davies
Jan 23, 2013·Journal of Pharmacokinetics and Pharmacodynamics·Hugo GeertsRobert Carr
Oct 12, 2010·Internal and Emergency Medicine·Carlo RostagnoGian Franco Gensini
Aug 16, 2005·Current Psychiatry Reports·Thomas W Weickert, Terry E Goldberg
Sep 18, 2001·Current Psychiatry Reports·P F BuckleyB Singer
Mar 17, 2004·Current Opinion in Pharmacology·Herbert Y Meltzer
Dec 4, 2003·Progress in Neuro-psychopharmacology & Biological Psychiatry·Shitij Kapur, David Mamo
Jan 31, 2004·Progress in Neuro-psychopharmacology & Biological Psychiatry·Yung-Chieh YenMian-Yoon Chong
Apr 20, 2004·Progress in Neuro-psychopharmacology & Biological Psychiatry·Claire AdvokatJoseph E Comaty
Aug 9, 2003·Lancet·J GeddesN Freemantle
Jun 6, 2003·Neuroscience and Biobehavioral Reviews·Albert Hung Choy Wong, Hubert H M Van Tol
Jan 25, 2003·Health Policy·Alan Maynard, David McDaid
Aug 19, 2003·Progress in Neuro-psychopharmacology & Biological Psychiatry·Yasuhiro Kaneda, Tetsuro Ohmori
Feb 19, 2003·Journal of Pain and Symptom Management·Irene J HigginsonCharles E Normand
Jun 8, 2002·European Psychiatry : the Journal of the Association of European Psychiatrists·Emmanuel Stip
Dec 31, 2002·European Psychiatry : the Journal of the Association of European Psychiatrists·Blanca SantamaríaFrancisco J de Abajo
Aug 21, 2003·European Psychiatry : the Journal of the Association of European Psychiatrists·Ann M Mortimer
Sep 5, 2002·European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology·M M MarcusT H Svensson
Dec 9, 2003·European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology·Gerard W K HugenholtzAntoine C G Egberts
Apr 2, 2009·Psychological Medicine·S LeuchtJ M Davis
Sep 11, 2009·Psychological Medicine·Shôn Lewis
Nov 13, 2003·Epidemiologia e psichiatria sociale·Andrea Cipriani, J Geddes

Citations

Jan 1, 1987·Schizophrenia Bulletin·S R KayL A Opler
Sep 1, 1986·Controlled Clinical Trials·R DerSimonian, N Laird
Feb 1, 1995·JAMA : the Journal of the American Medical Association·K F SchulzD G Altman
Dec 30, 1995·Statistics in Medicine·T C SmithA Thomas
May 2, 2000·The British Journal of Psychiatry : the Journal of Mental Science·S W Woods

Related Concepts

Amisulpride
Antipsychotic Effect
Atypical Antipsychotic [EPC]
Meta Analysis (Statistical Procedure)
Classification
Assay OF Haloperidol
Olanzapine
Seroquel
Schizophrenia
Dibenzothiazepines

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