Evidence map›Paper›PMID 26460229›Full record

Trial reportMolecular psychiatry2016

Optimal duration of risperidone or olanzapine adjunctive therapy to mood stabilizer following remission of a manic episode: A CANMAT randomized double-blind trial.

L N Yatham, S Beaulieu, A Schaffer, M Kauer-Sant'Anna, F Kapczinski, B Lafer, V Sharma, S V Parikh, A Daigneault, H Qian and 12 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Molecular psychiatry, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01977300 (Atypical Antipsychotics for Continuation and Maintenance Treatment After an Acute Manic Episode), which is not on this map. Cited by 22 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 5 pooled it
4.2field-weighted citation impact, top 5% of its field
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.

NCT01977300 phase3completednot on this map

Atypical Antipsychotics for Continuation and Maintenance Treatment After an Acute Manic Episode

TypeinterventionalSponsorUniversity of British ColumbiaRan2003 to 2011Enrolled159ConditionsBipolar I DisorderArmsValproate, Lithium, Risperidone, Olanzapine, Placebo
3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 5 syntheses or guidelines pooled it, 62 citations in OpenAlex.

  1. Pooled it
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  15. Evidence-Based Principles for Bipolar Disorder Treatment.Focus (American Psychiatric Publishing) · 2019
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

22 authors at 16 institutions in 2 countries.

L N YathamDepartment of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
S BeaulieuDouglas Hospital, McGill University, Montreal, QC, Canada.
A SchafferSunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
M Kauer-Sant'AnnaBipolar Disorder Program and Laboratory of Molecular Psychiatry, National Institute for Translational Medicine, INCT-TM, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
F KapczinskiBipolar Disorder Program and Laboratory of Molecular Psychiatry, National Institute for Translational Medicine, INCT-TM, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
B LaferBipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, Sao Paulo, Brazil.
V SharmaDepartment of Psychiatry, Western University, London, ON, Canada.
S V ParikhDepartment of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.
A DaigneaultDepartment of Psychiatry, Université de Montréal, Montreal, QC, Canada.
H QianCentre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
D J BondDepartment of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
P H SilverstoneDepartment of Psychiatry, University of Alberta, Edmonton, AB, Canada.
N WaljiDepartment of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
R MilevDepartment of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada.
P BaruchInstitut universitaire en santé mentale de Québec, Quebec, QC, Canada.
A da CunhaHospital Universitario de Santa Maria, Santa Maria, Brazil.
J QuevedoLaboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, Brazil.
R DiasBipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, Sao Paulo, Brazil.
M KunzBipolar Disorder Program and Laboratory of Molecular Psychiatry, National Institute for Translational Medicine, INCT-TM, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
L T YoungDepartment of Psychiatry, University of Toronto, Toronto, ON, Canada.
R W LamDepartment of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
H WongSchool of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.
University of British Columbia · CAHospital de Clínicas de Porto Alegre · BRUniversidade de São Paulo · BRHospital Universitário de Santa Maria · BRInstitut Universitaire en Santé Mentale de Québec · CAMcGill University · CAQueen's University · CASt. Paul's Hospital · CASunnybrook Health Science Centre · CAUniversidade do Sul de Santa Catarina · BRUniversidade Federal do Rio Grande do Sul · BRUniversité de Montréal · CAUniversity Health Network · CAUniversity of Alberta · CAUniversity of Toronto · CAWestern University · CA

Funding

CIHR
6 · The paper itself

Abstract

Atypical antipsychotic adjunctive therapy to lithium or valproate is effective in treating acute mania. Although continuation of atypical antipsychotic adjunctive therapy after mania remission reduces relapse of mood episodes, the optimal duration is unknown. As many atypical antipsychotics cause weight gain and metabolic syndrome, they should not be continued unless the benefits outweigh the risks. This 52-week double-blind placebo-controlled trial recruited patients with bipolar I disorder (n=159) who recently remitted from a manic episode during treatment with risperidone or olanzapine adjunctive therapy to lithium or valproate. Patients were randomized to one of three conditions: discontinuation of risperidone or olanzapine and substitution with placebo at (i) entry ('0-weeks' group) or (ii) at 24 weeks after entry ('24-weeks' group) or (iii) continuation of risperidone or olanzapine for the full duration of the study ('52-weeks' group). The primary outcome measure was time to relapse of any mood episode. Compared with the 0-weeks group, the time to any mood episode was significantly longer in the 24-weeks group (hazard ratio (HR) 0.53; 95% confidence interval (CI): 0.33, 0.86) and nearly so in the 52-weeks group (HR: 0.63; 95% CI: 0.39, 1.02). The relapse rate was similar in the 52-weeks group compared with the 24-weeks group (HR: 1.18; 95% CI: 0.71, 1.99); however, sub-group analysis showed discordant results between the two antipsychotics (HR: 0.48, 95% CI: 0.17; 1.32 olanzapine patients; HR: 1.85, 95% CI: 1.00, 3.41 risperidone patients). Average weight gain was 3.2 kg in the 52-weeks group compared with a weight loss of 0.2 kg in the 0-weeks and 0.1 kg in the 24-weeks groups. These findings suggest that risperidone or olanzapine adjunctive therapy for 24 weeks is beneficial but continuation of risperidone beyond this period does not reduce the risk of relapse. Whether continuation of olanzapine beyond this period reduces relapse risk remains unclear but the potential benefit needs to be weighed against an increased risk of weight gain.

Indexed as

AdultAntimanic AgentsAntipsychotic AgentsBenzodiazepinesBipolar DisorderCombined Modality TherapyDouble-Blind MethodFemaleHumansLithiumMaleOlanzapineRisperidoneTime FactorsWeight GainAntimanic AgentsAntipsychotic AgentsBenzodiazepinesLithiumOlanzapineRisperidone

Identifiers

PMID26460229
PMCPMC4960445
OpenAlexW2213525431

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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.