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Dose-response meta-analysis of antipsychotic drugs for acute schizophrenia

American Journal of Psychiatry Mar 03, 2020

Leucht S, et al. - Since the dose-response links of antipsychotic drugs for schizophrenia are not properly determined, so, researchers intended to fill this knowledge gap by performing dose-response meta-analyses. They identified all placebo-controlled dose-finding investigations for 20 second-generation antipsychotic drugs and haloperidol (oral and long-acting injectable, LAI) in individuals with acute schizophrenia symptoms, by exploring various electronic databases. Overall 68 eligible studies were analyzed. The estimated 95% effective doses as well as the doses equal to 1 mg of oral risperidone, respectively, were: amisulpride for patients exhibiting positive symptoms, 537 mg/day and 85.8 mg; aripiprazole, 11.5 mg/day and 1.8 mg; aripiprazole LAI (lauroxil), 463 mg every 4 weeks and 264 mg; asenapine, 15.0 mg/day and 2.4 mg; brexpiprazole, 3.36 mg/day and 0.54 mg; haloperidol, 6.3 mg/day and 1.01 mg; iloperidone, 20.13 mg/day and 3.2 mg; lurasidone, 147 mg/day and 23.5 mg; olanzapine, 15.2 mg/day and 2.4 mg; olanzapine LAI, 277 mg every 2 weeks and 3.2 mg; paliperidone, 13.4 mg/day and 2.1 mg; paliperidone LAI, 120 mg every 4 weeks and 1.53 mg; quetiapine, 482 mg/day and 77 mg; risperidone, 6.3 mg/day and 1 mg; risperidone LAI, 36.6 mg every 2 weeks and 0.42 mg; sertindole, 22.5 mg/day and 3.6 mg; and ziprasidone, 186 mg/day and 30 mg. It was concluded that compared with the identified 95% effective doses, higher doses may on average not afford more efficacy in chronic schizophrenia patients with acute exacerbations. As dose-response curves of some drugs did not plateau, higher than currently licensed doses for these drugs might be tested in further trials.
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