Evidence map›Paper›PMID 18180760›Full record

SynthesisMolecular psychiatry2009

How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials.

S Leucht, D Arbter, R R Engel, W Kissling, J M Davis

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Molecular psychiatry, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01245348 (Relative Effectiveness of Schizophrenia Therapy), which is not on this map. Cited by 161 papers, 23 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
161citing papers in PubMed, 23 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01245348 completednot on this mapstarted 2010, after this paper: background citation

Relative Effectiveness of Schizophrenia Therapy (REST) Study

TypeobservationalSponsorMedco Health Solutions, Inc.Ran2010 to 2012Enrolled1,110ConditionsSchizophrenia, Bipolar DisorderArmsSULT4A1-1 genetic test
3 · Its place in the literature

Who cites it

161 citing papers in PubMed, 23 syntheses or guidelines pooled it.

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  5. Maintenance treatment with antipsychotic drugs for schizophrenia.The Cochrane database of systematic reviews · 2020
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  6. Disconnection of drug-response and placebo-response in acute-phase antipsychotic drug trials on schizophrenia? Meta-regression analysis.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2019
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  7. Haloperidol discontinuation for people with schizophrenia.The Cochrane database of systematic reviews · 2019
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  18. Quetiapine versus typical antipsychotic medications for schizophrenia.The Cochrane database of systematic reviews · 2013
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  19. Benzodiazepines for schizophrenia.The Cochrane database of systematic reviews · 2012
    Pooled it
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101 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

S LeuchtDepartment of Psychiatry and Psychotherapy, Klinik für Psychiatrie und Psychotherapie der TU-München, Klinikum rechts der Isar, Technische Universität München, München, Germany. stefan.leucht@lrz.tum.de
D Arbter
R R Engel
W Kissling
J M Davis

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

We conducted a systematic review and meta-analysis of randomized controlled trials that compared second-generation antipsychotic (SGA) drugs with placebo in schizophrenic patients and which considered 13 different outcome measures. Thirty-eight randomized controlled trials with 7323 participants were included. All SGA drugs were more effective than placebo, but the pooled effect size (ES) for overall symptoms (primary outcome) was moderate (-0.51). The absolute difference (RD) in responder rates was at 18% (41% responded to drug compared with 24% to placebo, number needed to treat=6). Similar ESs were found for the other efficacy parameters: negative symptoms (ES=-0.39), positive symptoms (ES=-0.48), depression (ES=-0.26), relapse (RD 20%) and discontinuation due to inefficacy (RD 17%). Curiously, the efficacy of haloperidol for negative and depressive symptoms was similar to that of the SGA drugs. In contrast to haloperidol, there was no difference in terms of EPS between any SGA drugs and placebo, and there was also no difference in terms of dropouts due to adverse events. Meta-regression showed a decline in treatment response over time, and a funnel plot suggested the possibility of publication bias. We conclude that the drug versus placebo difference of SGA drugs and haloperidol in recent trials was moderate, and that there is much room for more efficacious compounds. Whether methodological issues account in part for the relatively low efficacy ESs and the scarcity of adverse event differences compared with placebo needs to be established.

Indexed as

Randomized Controlled Trials as TopicAntipsychotic AgentsHumansMEDLINEPsychotic DisordersTreatment OutcomeAntipsychotic Agents

Identifiers

PMID18180760

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.