Kentaro Matsui1, Takahiro Tokumasu2, Yoshiteru Takekita3, Ken Inada1, Tetsufumi Kanazawa4, Taishiro Kishimoto5, Shotaro Takasu5, Hideaki Tani5, Seiichiro Tarutani6, Naoki Hashimoto7, Hiroki Yamada2, Yoshio Yamanouchi8, Hiroyoshi Takeuchi9. 1. Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan. 2. Department of Neuropsychiatry, Showa University School of Medicine, Tokyo, Japan. 3. Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan. 4. Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan. 5. Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. 6. Department of Psychiatry, Shin-abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan. 7. Department of Psychiatry, Hokkaido University School of Medicine, Hokkaido, Japan. 8. Department of Neuropsychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan. 9. Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. Electronic address: hirotak@dk9.so-net.ne.jp.
Abstract
BACKGROUND: While recent meta-analyses have reported the superiority of antipsychotic polypharmacy (APP) over antipsychotic monotherapy (APM) in schizophrenia, switching to APM can be beneficial in terms of side effects. To determine whether patients receiving APP should switch to APM or stay on APP, we conducted a systematic review and meta-analysis. METHODS: Randomized controlled trials (RCTs) examining a switch from APP to APM vs. staying on APP were systematically selected from a previous meta-analysis comparing APP with APM in patients with schizophrenia. In addition, we conducted an updated systematic literature search using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Data on study discontinuation, relapse, psychopathology, neurocognition, extrapyramidal symptoms, and body weight/body mass index (BMI) were extracted and synthesized. RESULTS: A total of 6 RCTs involving 341 patients were included. All studies examined a switch from 2 antipsychotic agents to a single agent. Clozapine-treated patients were included in 3 studies. There was a significant difference in study discontinuation due to all causes in favor of staying on APP (N = 6, n = 341, RR = 2.28, 95% CI = 1.50-3.46, P < 0.001). There were no significant differences in relapse, any psychopathology, neurocognition, extrapyramidal symptoms, or body weight/BMI between the 2 groups. The quality of evidence was low to very low. CONCLUSIONS: The findings suggest that clinicians should closely monitor patient condition when switching to APM after receiving 2 antipsychotics. Given the low to very low overall quality of the evidence, the findings should be considered preliminary and inconclusive.
BACKGROUND: While recent meta-analyses have reported the superiority of antipsychotic polypharmacy (APP) over antipsychotic monotherapy (APM) in schizophrenia, switching to APM can be beneficial in terms of side effects. To determine whether patients receiving APP should switch to APM or stay on APP, we conducted a systematic review and meta-analysis. METHODS: Randomized controlled trials (RCTs) examining a switch from APP to APM vs. staying on APP were systematically selected from a previous meta-analysis comparing APP with APM in patients with schizophrenia. In addition, we conducted an updated systematic literature search using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Data on study discontinuation, relapse, psychopathology, neurocognition, extrapyramidal symptoms, and body weight/body mass index (BMI) were extracted and synthesized. RESULTS: A total of 6 RCTs involving 341 patients were included. All studies examined a switch from 2 antipsychotic agents to a single agent. Clozapine-treated patients were included in 3 studies. There was a significant difference in study discontinuation due to all causes in favor of staying on APP (N = 6, n = 341, RR = 2.28, 95% CI = 1.50-3.46, P < 0.001). There were no significant differences in relapse, any psychopathology, neurocognition, extrapyramidal symptoms, or body weight/BMI between the 2 groups. The quality of evidence was low to very low. CONCLUSIONS: The findings suggest that clinicians should closely monitor patient condition when switching to APM after receiving 2 antipsychotics. Given the low to very low overall quality of the evidence, the findings should be considered preliminary and inconclusive.
Authors: Liselotte D de Mooij; Martijn Kikkert; Jan Theunissen; Aartjan T F Beekman; Lieuwe de Haan; Pim W R A Duurkoop; Henricus L Van; Jack J M Dekker Journal: Front Psychiatry Date: 2019-12-06 Impact factor: 4.157