Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta‐analysis and meta‐regression analysis

Galling, Britta; Roldán, Alexandra; Hagi, Katsuhiko; Rietschel, Liz; Walyzada, Frozan; Zheng, Wei; Cao, Xiao−Lan; Xiang, Yu‐Tao; Zink, Mathias; Kane, John M.; Nielsen, Jimmi; Leucht, Stefan; Correll, Christoph U.

doi:10.1002/wps.20387

Cited by 169 publications

(149 citation statements)

References 82 publications

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“…However, we found that blonanserin monotherapy and combination therapies with quetiapine and zotepine, and risperidone and zotepine, possibly increased the report of NMS. Treatment with AAA, including their combinations, is an important management option for patients with schizophrenia . Our results could be useful information for the treatment of mental disorders in real clinical practice, though further research with more data are needed to clarify this.…”

Section: Discussionmentioning

confidence: 81%

Adverse reaction reports of neuroleptic malignant syndrome induced by atypical antipsychotic agents in the Japanese Adverse Drug Event Report (JADER) database

Anzai

Takahashi

Watanabe

2018

Psychiatry Clin Neurosci

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Aim This study evaluates reports on neuroleptic malignant syndrome (NMS) as an adverse event associated with the use of atypical antipsychotic agents (AAA) in Japan. We examined NMS occurrence following monotherapy and combination therapy with AAA in real clinical practice using the Japanese Adverse Drug Event Report database. Methods Adverse drug reaction reports associated with the use of one or more AAA or haloperidol were analyzed. The odds ratios of NMS occurrence after monotherapy and combination therapy with AAA without typical antipsychotic agents (TAA) relative to those after haloperidol monotherapy were estimated using multiple logistic regression. Results Associated with the use of one or more AAA without TAA were 721 events of NMS in 11 071 cases. NMS occurrence after monotherapy with most AAA and their combinations had lower odds ratios than that after haloperidol use. However, the odds ratios after blonanserin monotherapy and combination therapies with quetiapine and zotepine, and risperidone and zotepine were estimated higher than 1. Conclusion Monotherapy or combination therapy with most AAA without TAA was not likely to cause NMS as an adverse reaction compared to haloperidol monotherapy. However, blonanserin monotherapy and combination therapies with quetiapine and zotepine, and risperidone and zotepine, possibly increase the report of NMS. Our results may provide useful information for medications such as AAA that are clinically used to treat mental disorders, though further research with more data are needed to clarify this.

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Section: Discussionmentioning

confidence: 81%

Adverse reaction reports of neuroleptic malignant syndrome induced by atypical antipsychotic agents in the Japanese Adverse Drug Event Report (JADER) database

Anzai

Takahashi

Watanabe

2018

Psychiatry Clin Neurosci

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“…Recent meta‐analyses indicate that there is some evidence of a small to moderate effect of combining an antidepressant with antipsychotic treatment for total symptom score improvement . Selective serotonin reuptake inhibitors (SSRIs) and mirtazapine (a noradrenergic, specific serotonergic agent) are the compounds that have been most often investigated.…”

Section: Antipsychotic‐antidepressant Combination Treatmentmentioning

confidence: 99%

Polypharmacy in schizophrenia

Baandrup

2020

Basic Clin Pharma Tox

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Schizophrenia is a severe mental disorder characterized by a heterogeneous symptom profile which comprises a clinical platform for widespread use of polypharmacy even though antipsychotic monotherapy is the recommended treatment regimen. This narrative review provides a summary of the current gap between evidence and practice for use of antipsychotic combination therapy in patients with schizophrenia. Antipsychotic polypharmacy is frequently prescribed instead of following international consensus of clozapine monotherapy in treatment‐resistant patients. Antipsychotic‐benzodiazepine combination therapy clearly has a role in the treatment of acute agitation whereas there is no evidence to support an effect on core schizophrenia symptoms when chronically prescribed. Antidepressants are typically added to antipsychotic treatment in case of persistent negative symptoms. Available evidence suggests that antidepressants may improve negative symptom control in schizophrenia. Combining an antipsychotic with an antiepileptic is not supported by any firm evidence, but individual mood stabilizers have come out positively in single trials. Generally, the evidence base for polypharmacy in schizophrenia maintenance treatment is sparse but may be warranted in certain clinical situations. Therapeutic benefits and side effects should be carefully monitored and considered to ensure a beneficial risk‐benefit ratio if prescribing polypharmacy for specific clinical indications.

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“…There are concerns about side effect burden and lack of robust evidence for benefit of use of antipsychotic combinations [12].…”

Section: Introductionmentioning

confidence: 99%

Prescribing trends in treatment-resistant schizophrenia

Görmez

Kurtulmuş

Can

2017

Psychiatry and Clinical Psychopharmacology

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Objectives: Schizophrenia is a common mental health condition associated with significant morbidity and excess early mortality. Treatment-resistant schizophrenia (TRS) occurs in about one in three patients diagnosed with schizophrenia. The aim of this study was to identify attitudes of a nationally representative sample of psychiatrists towards pharmacotherapy of patients with TRS, the potential factors related to their choice of various regimens, and to investigate the clinical outcomes of different methods employed. Methods: Psychiatrists were contacted through national e-groups and various psychiatry conventions. They provided information about their professional and demographic characteristics. They were asked to describe clinical and demographic characteristics of an adult patient with TRS under their care for at least 3 months. They reported on the medication change they made and the effect of this intervention on the positive symptoms and functioning of the patient. Results: Among the 207 patients reported on, only 28.7% were on monotherapy for TRS immediately before the change in medication. With the change made in treatment regime, 40.1% were switched to a different antipsychotic agent as monotherapy, 40.6% received combination therapy with two or more antipsychotic agents, 1.4% received high-dose antipsychotics, and 4.8% had augmentation with antidepressants or mood stabilizers. 13.1% psychiatrists employed more than one method. Of the whole sample, 48.3% were put on clozapine either as monotherapy or with other medications. The monotherapy and combination groups were compared in terms of characteristics of patients and prescribers, which revealed no significant difference (p > .05). There was also no difference found on the outcome variables of two groups (p > .05). Conclusions: Although polypharmacy was found to be a common practice, there seemed to be a comparably good ratio of clozapine utilization and of attempts of switching to monotherapy among the prescribers. There were no significant patient-or prescriber-related factors in relation to preference of treatment regimens, which need further investigation on larger samples. ARTICLE HISTORY

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Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta‐analysis and meta‐regression analysis

Cited by 169 publications

References 82 publications

Adverse reaction reports of neuroleptic malignant syndrome induced by atypical antipsychotic agents in the Japanese Adverse Drug Event Report (JADER) database

Adverse reaction reports of neuroleptic malignant syndrome induced by atypical antipsychotic agents in the Japanese Adverse Drug Event Report (JADER) database

Polypharmacy in schizophrenia

Prescribing trends in treatment-resistant schizophrenia

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