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Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics

Few controlled trials compared second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) regarding relapse prevention in schizophrenia. We conducted a systematic review/meta-analysis of randomized trials, lasting ≥6 months comparing SGAs with FGAs in schizophrenia. Primary...

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Autores principales: Kishimoto, Taishiro, Agarwal, Vishesh, Kishi, Taro, Leucht, Stefan, Kane, John M., Correll, Christoph U.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320691/
https://www.ncbi.nlm.nih.gov/pubmed/22124274
http://dx.doi.org/10.1038/mp.2011.143
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author Kishimoto, Taishiro
Agarwal, Vishesh
Kishi, Taro
Leucht, Stefan
Kane, John M.
Correll, Christoph U.
author_facet Kishimoto, Taishiro
Agarwal, Vishesh
Kishi, Taro
Leucht, Stefan
Kane, John M.
Correll, Christoph U.
author_sort Kishimoto, Taishiro
collection PubMed
description Few controlled trials compared second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) regarding relapse prevention in schizophrenia. We conducted a systematic review/meta-analysis of randomized trials, lasting ≥6 months comparing SGAs with FGAs in schizophrenia. Primary outcome was study-defined relapse; secondary outcomes included relapse at 3, 6 and 12 months, treatment failure, hospitalization, and dropout due to any cause, non-adherence and intolerability. Pooled relative risk (RR) [+/−95%CIs] was calculated using random-effects model, with numbers-needed-to-treat (NNT) calculations where appropriate. Across 23 studies (n=4,504, mean duration=61.9+/−22.4 weeks), none of the individual SGAs outperformed FGAs (mainly haloperidol) regarding study-defined relapse, except for isolated, single trial-based superiority, and except for risperidone's superiority at 3 and 6 months when requiring >/=3 trials. Grouped together, however, SGAs prevented relapse more than FGAs (29.0% vs. 37.5%, RR=0.80, CI:0.70–0.91, p=.0007, I(2)=37%; NNT=17, CI:10–50, p=.003). SGAs were also superior regarding relapse at 3, 6 and 12 months (p=.04, p<.0001, p=.0001), treatment failure (p=.003) and hospitalization (p=.004). SGAs showed trend-level superiority for dropout due to intolerability (p=.05). Superiority of SGAs regarding relapse was modest (NNT=17), but confirmed in double-blind trials, first- and multi-episode patients, using preferentially or exclusively raw or estimated relapse rates, and for different haloperidol equivalent-comparator doses. There was no significant heterogeneity or publication bias. The relevance of the somewhat greater efficacy of SGAs over FGAs on several relevant outcomes depends on whether SGAs form a meaningful group and whether mid- or low-potency FGAs differ from haloperidol. Regardless, treatment selection needs to be individualized considering patient- and medication-related factors.
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spelling pubmed-33206912013-07-01 Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics Kishimoto, Taishiro Agarwal, Vishesh Kishi, Taro Leucht, Stefan Kane, John M. Correll, Christoph U. Mol Psychiatry Article Few controlled trials compared second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) regarding relapse prevention in schizophrenia. We conducted a systematic review/meta-analysis of randomized trials, lasting ≥6 months comparing SGAs with FGAs in schizophrenia. Primary outcome was study-defined relapse; secondary outcomes included relapse at 3, 6 and 12 months, treatment failure, hospitalization, and dropout due to any cause, non-adherence and intolerability. Pooled relative risk (RR) [+/−95%CIs] was calculated using random-effects model, with numbers-needed-to-treat (NNT) calculations where appropriate. Across 23 studies (n=4,504, mean duration=61.9+/−22.4 weeks), none of the individual SGAs outperformed FGAs (mainly haloperidol) regarding study-defined relapse, except for isolated, single trial-based superiority, and except for risperidone's superiority at 3 and 6 months when requiring >/=3 trials. Grouped together, however, SGAs prevented relapse more than FGAs (29.0% vs. 37.5%, RR=0.80, CI:0.70–0.91, p=.0007, I(2)=37%; NNT=17, CI:10–50, p=.003). SGAs were also superior regarding relapse at 3, 6 and 12 months (p=.04, p<.0001, p=.0001), treatment failure (p=.003) and hospitalization (p=.004). SGAs showed trend-level superiority for dropout due to intolerability (p=.05). Superiority of SGAs regarding relapse was modest (NNT=17), but confirmed in double-blind trials, first- and multi-episode patients, using preferentially or exclusively raw or estimated relapse rates, and for different haloperidol equivalent-comparator doses. There was no significant heterogeneity or publication bias. The relevance of the somewhat greater efficacy of SGAs over FGAs on several relevant outcomes depends on whether SGAs form a meaningful group and whether mid- or low-potency FGAs differ from haloperidol. Regardless, treatment selection needs to be individualized considering patient- and medication-related factors. 2011-11-29 2013-01 /pmc/articles/PMC3320691/ /pubmed/22124274 http://dx.doi.org/10.1038/mp.2011.143 Text en Users may view, print, copy, download and text and data- mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Kishimoto, Taishiro
Agarwal, Vishesh
Kishi, Taro
Leucht, Stefan
Kane, John M.
Correll, Christoph U.
Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
title Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
title_full Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
title_fullStr Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
title_full_unstemmed Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
title_short Relapse Prevention in Schizophrenia: A Systematic Review and Meta-Analysis of Second-Generation Antipsychotics versus First-Generation Antipsychotics
title_sort relapse prevention in schizophrenia: a systematic review and meta-analysis of second-generation antipsychotics versus first-generation antipsychotics
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320691/
https://www.ncbi.nlm.nih.gov/pubmed/22124274
http://dx.doi.org/10.1038/mp.2011.143
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