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

American Journal of Psychiatry Apr 07, 2020

Leucht S, et al. - In order to define the dose-response relationships of antipsychotic drugs for schizophrenia researchers conducted dose-response meta-analyses. Multiple electronic databases (through November 2018) were searched for all placebo-controlled dose-finding studies for 20 second-generation antipsychotic drugs and haloperidol (oral and long-acting injectable, LAI) in people with acute schizophrenia symptoms. They identified 68 studies meeting the inclusion criteria. Following were the 95% effective doses and the doses equivalent to 1 mg of oral risperidone, respectively: amisulpride for patients with 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. Doses higher than the identified 95% effective doses may on average not yield more efficacy in chronic schizophrenia cases with acute exacerbations. Further trials may test higher than currently licensed doses of some drugs, because their dose-response curves did not plateau.  

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