"n , particularly inadequate allocation conceal - ment , has long been reported as a potential reason for overestimation of efficacy ( Gotzsche et al . , 2006 ; Juni et al . , 2001 ; Schulz et al . , 1994 ) . Recently , it has also been suggested that trials of antipsychotics in patients with schizophrenia sponsored by the pharmaceutical industry ( Gotzsche et al . , 2006 ; Leucht et al . , 2009b ) or trials administering higher doses of olanzapine ( Parks et al . , 2009 ) might influence the effectiveness of treatment . While this study found some significant differences in results when studies were divided according to method of allocation concealment ( adequate vs . unclear ) , sponsor of studies ( pu"
[Show abstract][Hide abstract] ABSTRACT: Objective: This comprehensive review and meta-analysis compared the effectiveness of olanzapine and other antipsychotics in schizophrenia treatment, defining effectiveness as time to all-cause medication discontinuation (primary) and as all-cause treatment discontinuation rates. This study examined randomized clinical trials (RCTs) and observational non-interventional studies. Experimental procedures: Schizophrenia studies that compared olanzapine with individual first- (FGAs) and/or second-generation antipsychotics (SGAs) were included in the meta-analyses. Hazard ratios (HR), risk ratios (RR), and their associated 95% confidence intervals were extracted for RCTs and observational studies. Sensitivity analyses assessed the impact of sources of funding, dose of olanzapine, and allocation concealment method on final results. Results: There were 60 RCTs (N=33,360) and 27 observational studies (N=202,591) included. On time to all-cause medication discontinuation, olanzapine was significantly better than aripiprazole, quetiapine, risperidone, ziprasidone and perphenazine for RCTs and better than amisulpride, risperidone, haloperidol, and perphenazine for observational studies. There were no significant differences between olanzapine and clozapine in RCTs or observational studies. All-cause discontinuation rates in RCTs were significantly lower for olanzapine compared to all comparators except amisulpride and clozapine. In observational studies, olanzapine was less effective than clozapine. Industry-sponsored studies favored olanzapine when compared to haloperidol and perphenazine; higher dose of olanzapine favored quetiapine and perphenazine when compared to olanzapine; method of allocation concealment did not generally affect the results. Conclusion: Using a global measure of medication effectiveness (time to all-cause medication discontinuation), olanzapine appears to be more effective - in both RCTs and observational studies - than most SGAs and FGAs, except for clozapine.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 05/2012; 23(2). DOI:10.1016/j.euroneuro.2012.05.001 · 5.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The clinical practice guidelines of the Drug Commission of the German Medical Association (DCGMA) are intended to provide a solid basis of therapeutic rationality. Being evidence-based and practice-orientated, these guidelines are not supposed to restrict or replace independent and responsible action. The DCGMA board selects the topics with their importance to general practice being a relevant criterion. A multidisciplinary working group comprising DCGMA experts that have no conflict of interest with the pharmaceutical industry is then established. A panel of office-based physicians is involved in the process of establishing consensus. Once the paper is accepted, the respective professional societies are consulted. Finally, the guideline is released by the DCGMA board and distributed via different publications and educational events. DCGMA clinical practice guidelines are developed in consideration of the best available evidence; however, for many questions of pharmacological treatment the evidence remains fragmentary. In addition, there are many points where the results of clinical research, currently often funded by pharmaceutical companies, might not be unbiased.
Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 07/2008; 102(4). DOI:10.1016/j.zefq.2008.04.005
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