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- Document type:
- Journal Article
- Author(s):
- Galling, Britta; Roldán, Alexandra; Hagi, Katsuhiko; Rietschel, Liz; Walyzada, Frozan; Zheng, Wei; Cao, Xiao-Lan; Xiang, Yu-Tao; Zink, Mathias; Kane, John M; Nielsen, Jimmi; Leucht, Stefan; Correll, Christoph U
- Title:
- Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis.
- Abstract:
- Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=-0.53, 95% CI: -0.87 to -0.19, p=0.002). However, superiority was only apparent in open-label and low-quality trials (both p<0.001), but not in double-blind and high-quality ones (p=0.120 and 0.226, respectively). Study-defined response was similar between antipsychotic augmentation and monotherapy (14 studies, N=938, risk ratio = 1.19, 95% CI: 0.99 to 1.42, p=0.061), being clearly non-significant in double-blind and high-quality studies (both p=0.990). Findings were replicated in clozapine and non-clozapine augmentation studies. No differences emerged regarding all-cause/specific-cause discontinuation, global clinical impression, as well as positive, general and depressive symptoms. Negative symptoms improved more with augmentation treatment (18 studies, N=931, SMD=-0.38, 95% CI: -0.63 to -0.13, p<0.003), but only in studies augmenting with aripiprazole (8 studies, N=532, SMD=-0.41, 95% CI: -0.79 to -0.03, p=0.036). Few adverse effect differences emerged: D2 antagonist augmentation was associated with less insomnia (p=0.028), but more prolactin elevation (p=0.015), while aripiprazole augmentation was associated with reduced prolactin levels (p<0.001) and body weight (p=0.030). These data suggest that the common practice of antipsychotic augmentation in schizophrenia lacks double-blind/high-quality evidence for efficacy, except for negative symptom reduction with aripiprazole augmentation.
- Journal title abbreviation:
- World Psychiatry
- Year:
- 2017
- Journal volume:
- 16
- Journal issue:
- 1
- Pages contribution:
- 77-89
- Language:
- eng
- Fulltext / DOI:
- doi:10.1002/wps.20387
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/28127934
- Print-ISSN:
- 1723-8617
- TUM Institution:
- Klinik und Poliklinik für Psychiatrie und Psychotherapie
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