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A network meta-analysis of efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia.

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Title: A network meta-analysis of efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia.
Authors: Dong, Shimeng (AUTHOR), Schneider-Thoma, Johannes (AUTHOR), Bighelli, Irene (AUTHOR), Siafis, Spyridon (AUTHOR), Wang, Dongfang (AUTHOR), Burschinski, Angelika (AUTHOR), Schestag, Kristina (AUTHOR), Samara, Myrto (AUTHOR), Leucht, Stefan (AUTHOR)
Source: European Archives of Psychiatry & Clinical Neuroscience. Jun2024, Vol. 274 Issue 4, p917-928. 12p.
Subjects: Antipsychotic agents, Schizophrenia, Clozapine, Weight gain, Olanzapine
Abstract: Objective: Clozapine is considered as the standard treatment for this subgroup, but the evidence is not unequivocal. There are several potential alternatives being used because of the possible adverse effects of clozapine. We aimed to examine the efficacy and adverse events of different antipsychotics in treatment-resistant schizophrenia by performing a network meta-analysis. Methods: We searched the Cochrane Schizophrenia Group register for randomized-controlled trials (up to March 06, 2022) and MEDLINE (up to January 20, 2023). We included blinded and open studies and participants with a broad definition of treatment resistance. The primary outcome was overall symptoms of schizophrenia; secondary outcomes were response to treatment, positive and negative symptoms of schizophrenia, discontinuation, side effects, quality of life, and functioning. The study was registered in Open Science Framework (https://osf.io/9nf2y/). Results: We included 60 studies involving 6838 participants in the network meta-analysis. In the primary outcome, clozapine and olanzapine were more efficacious than risperidone, haloperidol, fluphenazine, sertindole, chlorpromazine, and quetiapine (range of mean SMDs, − 0.11 to − 0.48). The difference between clozapine and olanzapine was trivial and uncertain (SMD − 0.05, 95% CI, − 0.21 to 0.11). The result of other efficacy outcomes as well as subgroup and sensitivity analyses were consistent with the primary analysis. Clozapine and olanzapine were associated with more weight gain, and clozapine was associated with more sedation events compared to many other antipsychotics. Conclusions: Clozapine remains the gold standard for patients with treatment-resistant schizophrenia. Olanzapine seems to be second-best and could be tried before switching to clozapine. [ABSTRACT FROM AUTHOR]
Copyright of European Archives of Psychiatry & Clinical Neuroscience is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: A network meta-analysis of efficacy, acceptability, and tolerability of antipsychotics in treatment-resistant schizophrenia.
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  Data: <searchLink fieldCode="AR" term="%22Dong%2C+Shimeng%22">Dong, Shimeng</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schneider-Thoma%2C+Johannes%22">Schneider-Thoma, Johannes</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bighelli%2C+Irene%22">Bighelli, Irene</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Siafis%2C+Spyridon%22">Siafis, Spyridon</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wang%2C+Dongfang%22">Wang, Dongfang</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Burschinski%2C+Angelika%22">Burschinski, Angelika</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schestag%2C+Kristina%22">Schestag, Kristina</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Samara%2C+Myrto%22">Samara, Myrto</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Leucht%2C+Stefan%22">Leucht, Stefan</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Archives+of+Psychiatry+%26+Clinical+Neuroscience%22">European Archives of Psychiatry & Clinical Neuroscience</searchLink>. Jun2024, Vol. 274 Issue 4, p917-928. 12p.
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  Data: <searchLink fieldCode="DE" term="%22Antipsychotic+agents%22">Antipsychotic agents</searchLink><br /><searchLink fieldCode="DE" term="%22Schizophrenia%22">Schizophrenia</searchLink><br /><searchLink fieldCode="DE" term="%22Clozapine%22">Clozapine</searchLink><br /><searchLink fieldCode="DE" term="%22Weight+gain%22">Weight gain</searchLink><br /><searchLink fieldCode="DE" term="%22Olanzapine%22">Olanzapine</searchLink>
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  Data: Objective: Clozapine is considered as the standard treatment for this subgroup, but the evidence is not unequivocal. There are several potential alternatives being used because of the possible adverse effects of clozapine. We aimed to examine the efficacy and adverse events of different antipsychotics in treatment-resistant schizophrenia by performing a network meta-analysis. Methods: We searched the Cochrane Schizophrenia Group register for randomized-controlled trials (up to March 06, 2022) and MEDLINE (up to January 20, 2023). We included blinded and open studies and participants with a broad definition of treatment resistance. The primary outcome was overall symptoms of schizophrenia; secondary outcomes were response to treatment, positive and negative symptoms of schizophrenia, discontinuation, side effects, quality of life, and functioning. The study was registered in Open Science Framework (https://osf.io/9nf2y/). Results: We included 60 studies involving 6838 participants in the network meta-analysis. In the primary outcome, clozapine and olanzapine were more efficacious than risperidone, haloperidol, fluphenazine, sertindole, chlorpromazine, and quetiapine (range of mean SMDs, − 0.11 to − 0.48). The difference between clozapine and olanzapine was trivial and uncertain (SMD − 0.05, 95% CI, − 0.21 to 0.11). The result of other efficacy outcomes as well as subgroup and sensitivity analyses were consistent with the primary analysis. Clozapine and olanzapine were associated with more weight gain, and clozapine was associated with more sedation events compared to many other antipsychotics. Conclusions: Clozapine remains the gold standard for patients with treatment-resistant schizophrenia. Olanzapine seems to be second-best and could be tried before switching to clozapine. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Archives of Psychiatry & Clinical Neuroscience is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: Jun2024
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