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Meta-analysis of drop-out rates in randomised clinical trials, comparing typical and atypical antipsychotics in the treatment of schizophrenia

Submitted to European Psychiatry. A poster of this work was presented at the WPA International Congress in Florence (November 10–13, 2004). Poster session PO1: Psychotic Disorders

Published online by Cambridge University Press:  16 April 2020

José Luis R. Martin ,
Víctor Pérez ,
Montse Sacristán ,
Fernando Rodríguez-Artalejo ,
Cristóbal Martínez  and
Enric Álvarez
José Luis R. Martin*
Affiliation:
Department of Clinical Research, Castilla-La Mancha Health Research Foundation (FISCAM), Edificio Bulevar, C/Berna, No. 2, Local 0-2, 45003 Toledo, Castilla-La Mancha, Spain University of Castilla-La Mancha, Toledo, Spain
Víctor Pérez
Affiliation:
Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain
Montse Sacristán
Affiliation:
Department of Clinical Research, Castilla-La Mancha Health Research Foundation (FISCAM), Edificio Bulevar, C/Berna, No. 2, Local 0-2, 45003 Toledo, Castilla-La Mancha, Spain
Fernando Rodríguez-Artalejo
Affiliation:
Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain
Cristóbal Martínez
Affiliation:
Department of Clinical Pharmacology, Alarcos Hospital, Ciudad Real, Spain
Enric Álvarez
Affiliation:
Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain
*
*Corresponding author. Tel.: +34 92 528 1144; fax: +34 92 528 1149. E-mail address:[email protected] (J.L.R. Martin).
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Abstract

Objective

To assess antipsychotic medication in the treatment of schizophrenia, based on trial drop-out rates.

Methods

The studies included were randomised controlled trials that compared any of the four clinically best-established atypical antipsychotics (quetiapine, olanzapine, risperidone or clozapine) against either of two typical antipsychotics regarded as the gold standard (haloperidol or chlorpromazine).

Results

Meta-analysis indicated less risk of all-cause patient withdrawal from atypical medication trials where dosage was flexible, in both the short, relative risk (RR) 0.70 (95% CI 0.64–0.76), P < 0.00001, and long term, RR 0.72 (0.65–0.80), P < 0.00001. Similar results were observed for withdrawal due to adverse events, RR: 0.54 (0.41–0.72), P < 0.0001. Nevertheless, the favourable effects of atypical medication disappeared in trials relying on fixed dosage.

Conclusions

We detected a significant positive effect in terms of the outcome of treatment discontinuation for atypical versus typical medication, though only where the use of flexible rather than fixed doses (closer to an experimental control situation) was possible.

Keywords

Systematic reviewMeta-analysisSchizophreniaClinical trials
Type
Review
Information
European Psychiatry , Volume 21 , Issue 1 , January 2006 , pp. 11 - 20
Copyright
Copyright © Elsevier SAS 2006

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