Clozapine as a first- or second-line treatment in schizophrenia: a systematic review and meta-analysis

Acta Psychiatrica Scandinavica
C Okhuijsen-PfeiferJ J Luykx

Abstract

No consensus exists on whether clozapine should be prescribed in early stages of psychosis. This systematic review and meta-analysis therefore focus on the use of clozapine as first-line or second-line treatment in non-treatment-resistant patients. Articles were eligible if they investigated clozapine compared to another antipsychotic as a first- or second-line treatment in non-treatment-resistant schizophrenia spectrum disorders (SCZ) patients and provided data on treatment response. We performed random-effects meta-analyses. Fifteen articles were eligible for the systematic review (N = 314 subjects on clozapine and N = 800 on other antipsychotics). Our meta-analysis comparing clozapine to a miscellaneous group of antipsychotics revealed a significant benefit of clozapine (Hedges' g = 0.220, P = 0.026, 95% CI = 0.026-0.414), with no evidence of heterogeneity. In addition, a sensitivity analysis revealed a significant benefit of clozapine over risperidone (Hedges' g = 0.274, P = 0.030, 95% CI = 0.027-0.521). The few eligible trials on this topic suggest that clozapine may be more effective than other antipsychotics when used as first- or second-line treatment. Only large clinical trials may comprehensively probe disease stage-d...Continue Reading

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Citations

Sep 22, 2018·Acta Psychiatrica Scandinavica·P Homan, J M Kane
Jan 11, 2020·Der Nervenarzt·C U Correll
Apr 9, 2020·Acta Psychiatrica Scandinavica·H Verdoux, C Quiles
May 23, 2020·Clinical and Translational Science·Noraly StamJurjen J Luykx
Jan 9, 2020·The British Journal of Psychiatry : the Journal of Mental Science·Jurjen J LuykxHeidi Taipale
Jan 25, 2020·Acta Psychiatrica Scandinavica·R JonesR Upthegrove
Mar 24, 2020·Molecular Psychiatry·Pramod C NairTarun Bastiampillai
Feb 9, 2021·International Journal of Psychiatry in Clinical Practice·Ahmet KokurcanSibel Örsel
Dec 22, 2020·Focus : Journal of Life Long Learning in Psychiatry·Steven G PotkinOliver D Howes
Jul 10, 2021·Translational Neuroscience·Caroline Lahogue, Didier Pinault
Sep 24, 2021·Translational Psychiatry·Elias WagnerAlkomiet Hasan

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Software Mentioned

Comprehensive meta analysis
BioStat

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