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Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis
OBJECTIVE: 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. METHODS: Articles were eligible if they...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175356/ https://www.ncbi.nlm.nih.gov/pubmed/30218445 http://dx.doi.org/10.1111/acps.12954 |
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author | Okhuijsen‐Pfeifer, C. Huijsman, E. A. H. Hasan, A. Sommer, I. E. C. Leucht, S. Kahn, R. S. Luykx, J. J. |
author_facet | Okhuijsen‐Pfeifer, C. Huijsman, E. A. H. Hasan, A. Sommer, I. E. C. Leucht, S. Kahn, R. S. Luykx, J. J. |
author_sort | Okhuijsen‐Pfeifer, C. |
collection | PubMed |
description | OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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‐dependent superiority of clozapine and investigate overall tolerability. |
format | Online Article Text |
id | pubmed-6175356 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-61753562018-10-19 Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis Okhuijsen‐Pfeifer, C. Huijsman, E. A. H. Hasan, A. Sommer, I. E. C. Leucht, S. Kahn, R. S. Luykx, J. J. Acta Psychiatr Scand Systematic Review/Meta‐analysis OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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‐dependent superiority of clozapine and investigate overall tolerability. John Wiley and Sons Inc. 2018-09-14 2018-10 /pmc/articles/PMC6175356/ /pubmed/30218445 http://dx.doi.org/10.1111/acps.12954 Text en © 2018 The Authors Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Systematic Review/Meta‐analysis Okhuijsen‐Pfeifer, C. Huijsman, E. A. H. Hasan, A. Sommer, I. E. C. Leucht, S. Kahn, R. S. Luykx, J. J. Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
title | Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
title_full | Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
title_fullStr | Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
title_full_unstemmed | Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
title_short | Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
title_sort | clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis |
topic | Systematic Review/Meta‐analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175356/ https://www.ncbi.nlm.nih.gov/pubmed/30218445 http://dx.doi.org/10.1111/acps.12954 |
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