There is an enormous body of research concerned with schizophrenia and the use of antipsychotic drugs. A quick search on PubMed for ‘schizophrenia, antipsychotics and randomised controlled trials’ brings back nearly 2,000 articles!
The authors of a new systematic review and meta analysis published today in the Lancet, suggest that one area that has not been sufficiently addressed is the use of antipsychotic drugs (compared with placebo) to prevent relapse in patients with schizophrenia.
The new review includes 116 reports from 65 randomised trials published over the last 50 years. Trials were eligible if they looked at patients with schizophrenia who had become stabilised and then continued with or withdrawn from antipsychotics. The main outcome of interest was relapse between 7-12 months. The review appears to be well conducted with a good systematic search, a focus on safety and various functional outcomes, a random effects model and fixed effects model, plus a meta-regression analyses to look for heterogeneity.
Here’s what they found:
- Antipsychotic drugs significantly reduced relapse rates at 1 year
- Drugs 27% vs placebo 64%
- Risk ratio [RR] 0·40, 95% CI 0·33-0·49
- Number needed to treat to benefit [NNTB] 3, 95% CI 2-3
- Fewer patients given antipsychotic drugs than placebo were readmitted (but less than a third of relapsed patients had to be admitted)
- 10% vs 26%
- RR 0·38, 95% CI 0·27-0·55
- NNTB 5, 4-9
- Depot preparations reduced relapse (RR 0·31, 95% CI 0·21-0·41) more than did oral drugs (0·46, 0·37-0·57; p=0·03)
- Substantial heterogeneity in size of effect was recorded
But as you might expect, side effects were an issue:
- More patients given antipsychotic drugs than placebo:
- Gained weight (10% vs 6%; RR 2·07, 95% CI 2·31-3·25)
- Had movement disorders (16% vs 9%; 1·55, 1·25-1·93)
- Experienced sedation (13% vs 9%; 1·50, 1·22-1·84)
The authors conclude:
Maintenance treatment with antipsychotic drugs benefits patients with schizophrenia. The advantages of these drugs must be weighed against their side-effects. Future studies should focus on outcomes of social participation and clarify the long-term morbidity and mortality of these drugs.
Leucht, S. et al Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. The Lancet, Early Online Publication, 3 May 2012 doi:10.1016/S0140-6736(12)60239-6 [Abstract]