TY - JOUR
T1 - Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis
T2 - meta-analysis
AU - Crossley Karmelic, Nicolas
AU - Constante, Miguel
AU - McGuire, Philip
AU - Power, Paddy
PY - 2010/6
Y1 - 2010/6
N2 - Background
There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.
Aims
To examine the evidence base for this recommendation.
Method
Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.
Results
Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR)=0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD)=-0.1, 95% CI -0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD=-0.4, 95% CI -0.5 to -0.2).
Conclusions
There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.
AB - Background
There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.
Aims
To examine the evidence base for this recommendation.
Method
Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.
Results
Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR)=0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD)=-0.1, 95% CI -0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD=-0.4, 95% CI -0.5 to -0.2).
Conclusions
There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.
U2 - 10.1192/bjp.bp.109.066217
DO - 10.1192/bjp.bp.109.066217
M3 - Literature review
SN - 1472-1465
VL - 196
SP - 434
EP - 439
JO - British Journal of Psychiatry
JF - British Journal of Psychiatry
IS - 6
M1 - N/A
ER -