New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis.
Background: The clearest advantage of new generation, atypical antipsychotics is a reduced risk of extrapyramidal side-effects (EPS), compared with conventional compounds. These findings might have been biased by the use of the high-potency antipsychotic haloperidol as a comparator in most of the tr...
| Publicado en: | Lancet Vol. 361; no. 9369; pp. 1581 - 1590 |
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| Autores principales: | , , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Lancet
5/10/2003
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106878605&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106878605 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 5/10/2003 vid: 361 iid: 9369 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 106878605 106878605 NLM12747876 2003137833 10.1016/s0140-6736(03)13306-5 NLM12747876 106878605 ppf: 1581 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis. aug: au: Leucht S Wahlbeck K Hamann J Kissling W Leucht, Stefan Wahlbeck, Kristian Hamann, Johannes Kissling, Werner affil: Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, München, Germany. <> sug: subj: Antipsychotic Agents Adverse Effects Antipsychotic Agents Classification Antipsychotic Agents Therapeutic Use Basal Ganglia Diseases Chemically Induced Antipsychotic Agents Pharmacodynamics Chi Square Test Clinical Trials Comparative Studies Confidence Intervals Mantel-Haenszel Test Meta Analysis Research Methodology Schizophrenia Drug Therapy Human ab: Background: The clearest advantage of new generation, atypical antipsychotics is a reduced risk of extrapyramidal side-effects (EPS), compared with conventional compounds. These findings might have been biased by the use of the high-potency antipsychotic haloperidol as a comparator in most of the trials. We aimed to establish whether the new drugs induce fewer EPS than low-potency conventional antipsychotics.Methods: We did a meta-analysis of all randomised controlled trials in which new generation antipsychotics had been compared with low-potency (equivalent or less potent than chlorpromazine) conventional drugs. We included studies that met quality criteria A or B in the Cochrane Collaboration Handbook, and assessed quality with the Jadad scale. The primary outcome of interest was the number of patients who had at least one EPS. We used risk differences and 95% CIs as measures of effect size.Findings: We identified 31 studies with a total of 2320 participants. Of the new generation drugs, only clozapine was associated with significantly fewer EPS (RD=-0.15, 95% CI -0.26 to -0.4, p=0.008) and higher efficacy than low-potency conventional drugs. Reduced frequency of EPS seen with olanzapine was of borderline significance (-0.15, -0.31 to -0.01, p=0.07). Only one inconclusive trial of amisulpride, quetiapine, and risperidone and no investigations of ziprasidone and sertindole were identified, but some evidence indicates that zotepine and remoxipride do not lead to fewer EPS than low-potency antipsychotics. Mean doses less than 600 mg/day of chlorpromazine or its equivalent had no higher risk of EPS than new generation drugs. As a group, new generation drugs were moderately more efficacious than low-potency antipsychotics, largely irrespective of the comparator doses used.Interpretation: Optimum doses of low-potency conventional antipsychotics might not induce more EPS than new generation drugs. Potential advantages in efficacy of the new generation drugs should be a factor in clinical treatment decisions to use these rather than conventional drugs. pubtype: Academic Journal doctype: research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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