2024-01-18 15:17:17
An original network meta-analysis published online in Lancet Psychiatry evaluates the effectiveness of second-generation antipsychotics in schizophrenia by integrating both randomized controlled trials and observational studies. Hélène Verdoux, professor of psychiatry at the University of Bordeaux, offers us a summary.
Schematically, a network meta-analysis aims to synthesize the information collected in several studies, by comparing the different treatments available for a pathology, in order to then arrive at a classification. We therefore have much more information than by comparing a drug to a placebo or to a single reference drug.
Randomized controlled trials including people with a diagnosis of schizophrenia have important limitations, because patients agreeing to participate in these studies are not representative of people treated with antipsychotics under real prescription conditions. It is therefore important to take into account the data on the effectiveness of antipsychotics in “real life” where they are prescribed to people refusing care, consuming toxic substances, having suicidal thoughts, who are excluded from the trials.
This meta-analysis concerns 90,500 people whose antipsychotic use data comes from Swedish and Finnish registers, and 10,000 participants in randomized trials. The endpoint was relapse within 6 months following antipsychotic initiation, defined as hospitalization in observational studies.
In observational cohort data collected in registries, the five molecules (marketed in France) the most efficient are:
– la clozapine
– long-acting olanzapine
– long-acting aripiprazole
– olanzapine orally
– long-acting haloperidol.
The effectiveness of antipsychotics compared to placebo in randomized trials is 2.58 times higher to their effectiveness in “real life”. In controlled trials, oral forms have greater efficacy than that demonstrated in observational studies.
When the data from the two types of studies are combined, clozapine comes at the top of the ranking followed by oral olanzapine, then by long-acting olanzapine (for molecules marketed in France). Note the absence of data on amisulpride in this study.
This study therefore confirms the interest of clozapine and long-acting antipsychotics for relapse prevention. It also serves as a reminder that pharmacoepidemiological studies are particularly interesting for evaluating the effectiveness of antipsychotics, which is overestimated in randomized controlled trials due to the low representativeness of participants.
• Efficacy and effectiveness of antipsychotics in schizophrenia: network meta-analyses combining evidence from randomised controlled trials and real-world data, Lancet Psychiatry 2024 Jan 9:S2215-0366(23)00366-8.
Thank you to Hélène Verdoux for sharing with Mental Health readers the summary of this meta-analysis which she published on her Linkedin account.
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#Preventing #relapse #clozapine #longacting #antipsychotics
