Quetiapine versus other atypical antipsychotics for schizophrenia
ABSTRACT In many countries of the industrialised world second generation ('atypical') antipsychotic drugs have become the first line drug treatment for people with schizophrenia. It is not clear how the effects of the various second generation antipsychotic drugs differ.
To evaluate the effects of quetiapine compared with other second generation antipsychotic drugs for people with schizophrenia and schizophrenia-like psychosis.
We searched the Cochrane Schizophrenia Group Trials Register (April 2007), inspected references of all identified studies, and contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information.
We included all randomised control trials comparing oral quetiapine with oral forms of amisulpride, aripiprazole, clozapine, olanzapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis.
We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random-effects model.
The review currently includes 21 randomised control trials (RCTs) with 4101 participants. These trials provided data on four comparisons - quetiapine versus clozapine, olanzapine, risperidone or ziprasidone.A major limitation to all findings is the high number of participants leaving studies prematurely (57.6%) and the substantial risk of biases in studies. Efficacy data favoured olanzapine and risperidone compared with quetiapine (PANSS total score versus olanzapine:10 RCTs, n=1449, WMD 3.66 CI 1.93 to 5.39; versus risperidone: 9 RCTs, n=1953, WMD 3.09 CI 1.01 to 5.16), but clinical meaning is unclear. There were no clear mental state differences when quetiapine was compared with clozapine or ziprasidone.Compared with olanzapine, quetiapine produced slightly fewer movement disorders (6 RCTs, n=1090, RR use of antiparkinson medication 0.49 CI 0.3 to 0.79, NNH 25 CI 14 to 100) and less weight gain (7 RCTs, n=1173, WMD -2.81 CI -4.38 to -1.24) and glucose elevation, but more QTc prolongation (3 RCTs, n=643, WMD 4.81 CI 0.34 to 9.28). Compared with risperidone, quetiapine induced slightly fewer movement disorders (6 RCTs, n=1715, RR use of antiparkinson medication 0.5 CI 0.3 to 0.86, NNH 20 CI 10 to 100), less prolactin increase (6 RCTs, n=1731, WMD -35.28 CI -44.36 to -26.19) and some related adverse effects, but more cholesterol increase (5 RCTs, n=1433, WMD 8.61 CI 4.66 to 12.56). Compared with ziprasidone, quetiapine induced slightly fewer extrapyramidal adverse effects (1 RCT, n=522, RR use of antiparkinson medication 0.43 CI 0.2 to 0.93, NNH not estimable) and prolactin increase. On the other hand quetiapine was more sedating and led to more weight gain (2 RCTs, n=754, RR 2.22 CI 1.35 to 3.63, NNH 13 CI 8 to 33) and cholesterol increase than ziprasidone.
Best available evidence from trials suggests that most people who start quetiapine stop taking it within a few weeks. Comparisons with amisulpride, aripiprazole, sertindole and zotepine do not exist. Most data that has been reported within existing comparisons are of very limited value because of assumptions and biases within them. There is much scope for further research into the effects of this widely used drug.
[Show abstract] [Hide abstract]
ABSTRACT: Una paciente de 31 años afecta de retraso mental desarrolla parkinsonismo completo al asociar 300 mg/día de quetiapina con metronidazol. Como factor facilitador encontramos una sensibilidad idiosincrática a antipsicóticos.04/2012; 19(2):62-63. DOI:10.1016/j.psiq.2012.03.002
[Show abstract] [Hide abstract]
ABSTRACT: Resumen El cambio de antipsicóticos es un hecho frecuente en la práctica clínica y está sujeto a potenciales complicaciones clínicamente relevantes. Un grupo de expertos seleccionados por la Sociedad Española de Psiquiatría y la Sociedad Española de Psiquiatría Biológica ha revisado y discutido las pruebas provenientes de los ensayos clínicos y otros artículos relevantes para llegar a unas recomendaciones de consenso sobre el cambio de antipsicóticos. En este artículo se revisa toda la información que ha dado lugar a esas recomendaciones y que incluye: indica-ciones y contraindicaciones del cambio de antipsicóticos, aspectos farmacológicos, estrategias de cambio, el cambio por motivos de eficacia, el cambio por motivos de tolerabilidad (inclu-yendo los síntomas extrapiramidales y la discinesia tardía, el aumento de peso, los trastornos metabólicos, la hiperprolactinemia, la disfunción sexual, la sedación persistente y la prolon-gación del QT), el cambio por problemas de cumplimiento y el cambio de antipsicóticos en el trastorno bipolar. © 2011 SEP y SEPB. Publicado por Elsevier España, S.L. Todos los derechos reservados. Los miembros del Grupo RECAP aparecen al final del artículo. * Autor para correspondencia.Revista de Psiquiatría Biológica y Salud Mental 07/2011; DOI:10.1016/j.rpsm.2011.07.003 · 0.31 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Second-generation antipsychotics have been repeatedly shown to be superior to placebo. However, the comparative efficacy among these drugs has not been systematically evaluated. In this study, we used Mixed Treatment Comparison (MTC) procedures to elucidate the comparative efficacy and tolerability of second-generation antipsychotics. Seven antipsychotics were selected based on the availability of the relevant data. Data were gathered from a series of review article published by the Cochrane Collaboration. Six outcome measures were analyzed: 1) percentage of no clinically important response as defined by the original authors, 2) PANSS total score change from baseline to endpoint, 3) percentage of akathisia, 4) percentage of antiparkinson medication use, 5) percentage of total body weight increase more than 7%, and 6) percentage of drop-out due to any reasons. All the second-generation antipsychotics included in this study showed fairly similar efficacy but widely different tolerability. In terms of efficacy, amisulpride, clozapine and olanzapine were ranked higher than aripiprazole, quetiapine and ziprasidone. Clozapine and olanzapine were superior in terms of akathisia and extrapyramidal symptom risk, but, far more prone to induce clinically important weight gain. Using MTC methodology, we could line up the second generation antipsychotics according to their hierarchical superiority in terms of efficacy and tolerability. Though the wide overlap among the confidence intervals and the inconsistency between the direct and indirect comparison results may limit the validity of these results, it may still allow the important insights into the relative merits of the available drugs.Psychiatry investigation 01/2015; 12(1):46-54. DOI:10.4306/pi.2015.12.1.46 · 1.15 Impact Factor