Safety and tolerability of antipsychotic co-treatment in patients with schizophrenia: results from a systematic review and meta-analysis of randomized controlled trials
Por:
Galling, B, Roldan, A, Rietschel, L, Hagi, K, Walyzada, F, Zheng, W, Cao, XL, Xiang, YT, Kane, JM, Correll, CU
Publicada:
1 may 2016
Resumen:
Introduction: Antipsychotic co-treatment is common in schizophrenia, despite lacking evidence for its efficacy and safety.
Areas: We conducted a systematic search of PubMed/PsycInfo/CJN/WangFan/CBM without language restrictions from database inception until 05/25/2015 for randomized trials comparing antipsychotic monotherapy with antipsychotic co-treatment in >= 20 adults with schizophrenia reporting meta-analyzable adverse events (AEs) data. Meta-analyzing 67 studies (n=4,861, duration=10.3 +/- 5.2 weeks), antipsychotic co-treatment was similar to monotherapy regarding intolerability-related discontinuation (risk ratio (RR)=0.84, 95% confidence interval (CI)=0.53-1.33, p=0.455). While incidence of >= 1 AE was lower with antipsychotic co-treatment (RR=0.77, 95%CI=0.66-0.90, p=0.001), these results were solely driven by open-label and efficacy-focused studies. Adjunctive D2-antagonists lead to less nausea (RR=0.220, 95%CI=0.06-0.87, p=0.030) and insomnia (RR=0.26, 95%CI=0.08-0.86, p=0.028), but higher prolactin (SMD=2.20, 95%CI=0.43-3.96, p=0.015). Conversely, adjunctive partial D2-agonists (aripiprazole=100%) resulted in lower electrocardiogram abnormalities (RR=0.43, 95%CI=0.25-0.73, p=0.002), constipation (RR=0.45, 95%CI=0.25-0.79, p=0.006), drooling/hypersalivation (RR=0.14, 95%CI=0.07-0.29, p<0.001), prolactin (SMD=-1.77, 95%CI=-2.38, -1.15, p<0.001), total and LDL-cholesterol (SMD=-0.33, 95%CI=-0.55, -0.11, p=0.003; SMD=-0.33, 95%CI=-0.54, -0.10, p=0.004).
Expert opinion: No double-blind evidence for altered AE burden associated with antipsychotic co-treatment was found. However, AEs were insufficiently and incompletely reported and follow-up duration was modest. Adjunctive partial D2-agonists might be beneficial for counteracting several AEs. High-quality, long-term studies that comprehensively assess AEs are needed.
Filiaciones:
Galling, B:
Northwell Hlth, Zucker Hillside Hosp, Psychiat Res, Glen Oaks, NY USA
Roldan, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Psychiat, Inst Invest Biomed St Pau, E-08193 Barcelona, Spain
Rietschel, L:
Univ Bern, Univ Hosp Child & Adolescent Psychiat & Psychothe, Bern, Switzerland
Hagi, K:
Northwell Hlth, Zucker Hillside Hosp, Psychiat Res, Glen Oaks, NY USA
Sumitomo Dainippon Pharma Co Ltd, Med Affairs, Tokyo, Japan
Walyzada, F:
Northwell Hlth, Zucker Hillside Hosp, Psychiat Res, Glen Oaks, NY USA
Zheng, W:
Guangzhou Med Univ, Affilated Hosp, Guangzhou Huiai Hosp, Dept Psychiat,Guangzhou Brain Hosp, Guangzhou, Guangdong, Peoples R China
Cao, XL:
Chinese Univ Hong Kong, Dept Psychiat, Hong Kong, Hong Kong, Peoples R China
Xiang, YT:
Univ Macau, Unit Psychiat, Fac Hlth Sci, Macau, Peoples R China
Kane, JM:
Northwell Hlth, Zucker Hillside Hosp, Psychiat Res, Glen Oaks, NY USA
Hofstra North Shore LIJ Sch Med, Hempstead, NY USA
Feinstein Inst Med Res, Manhasset, NY USA
Albert Einstein Coll Med, Bronx, NY 10467 USA
Correll, CU:
Northwell Hlth, Zucker Hillside Hosp, Psychiat Res, Glen Oaks, NY USA
Hofstra North Shore LIJ Sch Med, Hempstead, NY USA
Feinstein Inst Med Res, Manhasset, NY USA
Albert Einstein Coll Med, Bronx, NY 10467 USA
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