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Figure 1
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Figuras y tablas -
Figure 2
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Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 1 Weight: Body weight (kg) ‐ switching to haloperidol decanoate from fluphenazine decanoate.
Figuras y tablas -
Analysis 1.1

Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 1 Weight: Body weight (kg) ‐ switching to haloperidol decanoate from fluphenazine decanoate.

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Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 2 Global state: Changing dose because of deterioration ‐ switching to haloperidol decanoate from fluphenazine decanoate.
Figuras y tablas -
Analysis 1.2

Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 2 Global state: Changing dose because of deterioration ‐ switching to haloperidol decanoate from fluphenazine decanoate.

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Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 3 Mental state: Deteriorated ‐ switching to haloperidol decanoate from fluphenazine decanoate.
Figuras y tablas -
Analysis 1.3

Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 3 Mental state: Deteriorated ‐ switching to haloperidol decanoate from fluphenazine decanoate.

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Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 4 Loss to follow up ‐ switching to haloperidol decanoate from fluphenazine decanoate.
Figuras y tablas -
Analysis 1.4

Comparison 1 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months), Outcome 4 Loss to follow up ‐ switching to haloperidol decanoate from fluphenazine decanoate.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 1 Weight: 1. Body weight (kg).
Figuras y tablas -
Analysis 2.1

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 1 Weight: 1. Body weight (kg).

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 2 Weight: 2a. BMI ‐ increase.
Figuras y tablas -
Analysis 2.2

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 2 Weight: 2a. BMI ‐ increase.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 3 Weight: 2b. BMI ‐ average change.
Figuras y tablas -
Analysis 2.3

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 3 Weight: 2b. BMI ‐ average change.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 4 Waist circumference ‐ increase.
Figuras y tablas -
Analysis 2.4

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 4 Waist circumference ‐ increase.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 5 Physiological measures: 1a. Average changes ‐ switching to quetiapine.
Figuras y tablas -
Analysis 2.5

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 5 Physiological measures: 1a. Average changes ‐ switching to quetiapine.

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Study

Group

N

% change

SE

stated p

lipids ‐ cholesterol

Newcomer 2008

Switch to aripiprazole

80

‐9.5

1.5

˜0.005

Newcomer 2008

Stay on olanzapine

76

‐3.3

1.6

lipids ‐ triglycerides

Newcomer 2008

Switch to aripiprazole

54

‐14.46

4.5 (estimate from graph)

˜0.002

Newcomer 2008

Stay on olanzapine

61

+ 5.3

5.6 (estimate from graph)

lipids ‐ low density lipoproteins

Newcomer 2008

Switch to aripiprazole

80

‐11.2

2.5

˜0.072

Newcomer 2008

Stay on olanzapine

76

‐4.7

2.7

lipids ‐ high density lipoproteins

Newcomer 2008

Switch to aripiprazole

80

+1.7

1.8

˜0.002

Newcomer 2008

Stay on olanzapine

76

‐5.9

1.7

Figuras y tablas -
Analysis 2.6

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 6 Physiological measures: 1b. Percentage changes ‐ switching to aripiprazole.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 7 Physiological measures: 1c. Average changes ‐ sugar.
Figuras y tablas -
Analysis 2.7

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 7 Physiological measures: 1c. Average changes ‐ sugar.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 8 Global state: 1a. Relapse.
Figuras y tablas -
Analysis 2.8

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 8 Global state: 1a. Relapse.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 9 Global state: 1b. Average change (CGI‐S, high decline = good) ‐ switching to aripiprazole.
Figuras y tablas -
Analysis 2.9

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 9 Global state: 1b. Average change (CGI‐S, high decline = good) ‐ switching to aripiprazole.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 10 Mental state: Average change (PANSS, high decline = good) ‐ switching to quetiapine.
Figuras y tablas -
Analysis 2.10

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 10 Mental state: Average change (PANSS, high decline = good) ‐ switching to quetiapine.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 11 Loss to follow‐up.
Figuras y tablas -
Analysis 2.11

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 11 Loss to follow‐up.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 12 Adverse events: 1. Serious adverse event.
Figuras y tablas -
Analysis 2.12

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 12 Adverse events: 1. Serious adverse event.

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Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 13 Adverse events: 2. Treatment emergent adverse events.
Figuras y tablas -
Analysis 2.13

Comparison 2 Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months), Outcome 13 Adverse events: 2. Treatment emergent adverse events.

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 1 Weight: gain (≥ 7% from baseline).
Figuras y tablas -
Analysis 3.1

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 1 Weight: gain (≥ 7% from baseline).

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 2 Global state: 1a. Average change (CGI‐I, high = good).
Figuras y tablas -
Analysis 3.2

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 2 Global state: 1a. Average change (CGI‐I, high = good).

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 3 Global state: 1b. Average change (CGI‐S, decline = good).
Figuras y tablas -
Analysis 3.3

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 3 Global state: 1b. Average change (CGI‐S, decline = good).

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 4 Mental state: Average change (PANSS, high decline = good).
Figuras y tablas -
Analysis 3.4

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 4 Mental state: Average change (PANSS, high decline = good).

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 5 Loss to follow up: 1a. Any reason.
Figuras y tablas -
Analysis 3.5

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 5 Loss to follow up: 1a. Any reason.

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 6 Loss to follow‐up: 1b. Various specific reasons.
Figuras y tablas -
Analysis 3.6

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 6 Loss to follow‐up: 1b. Various specific reasons.

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Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 7 Adverse events: Any event.
Figuras y tablas -
Analysis 3.7

Comparison 3 Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months), Outcome 7 Adverse events: Any event.

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Table 1. Suggested design of study

Methods

Allocation: randomised, clearly concealed and described. Blinding: double and tested. Duration: one year. CONSORT 2010 guidelines to be incorporated in the protocol and final report. Trial will be prospectively registered in the WHO ICTRP register. Protocol will be published in a peer‐reviewed journal.

Partipants

Diagnosis: people with schizophrenia or similar disorders (ICD 10/DSM IV). N = 400‐500.* Age: 18‐65. Sex: both. Weight: obese and/or metabolic problems(internationally accepted criteria for both). On olanzapine or risperidone. Exclusion: diabetes or hypercholesterolaemia requiring pharmacological management.

Interventions

1.Switching to aripiprazole/quetiapine+ routine advice on life style. N = 100. 2.Continuing on olanzapine/risperidone+ routine advice on life style. N = 100. 3. Switching to aripiprazole/quetiapine+ structured lifestyle modifications. N = 100. 4. Continuing on olanzapine/risperidone + structured lifestyle modifications. N = 100.

Outcomes

Body Weight** BMI**. Waist circumference. Metabolic measures: lipid profile, HbA1c,blood glucose**. Global state‐relapse, scales**. Mental state: scales**. Adverse events: scales. Physical health: vital signs Patient satisfaction**. Compliance/engagement with the services**. Loss to follow‐up. Economic outcomes.

Notes

* Powered to be able to identify a difference of ˜20% between groups for primary outcome with adequate degree of certainty. ** These were selected as our primary outcomes.

CONSORT‐ Consolidated Standards of Reporting Trials
HbA1c‐ Haemoglobin A1c
ICTRP‐ International Clinical Trials Registry Platform
WHO ‐ World Health Organisation

Figuras y tablas -
Table 1. Suggested design of study
Ir a la tabla de la revisión
Summary of findings for the main comparison. SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN compared to CONTINUATION ON PREVIOUS REGIMEN: 1a. DIFFERENT DEPOT from DEPOT‐medium term (3‐12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems

SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN compared to CONTINUATION ON PREVIOUS REGIMEN: 1a. DIFFERENT DEPOT from DEPOT‐medium term (3‐12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems

Patient or population: patients with people with schizophrenia who have neuroleptic‐induced weight or metabolic problems
Settings: in community
Intervention: SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN
Comparison: CONTINUATION ON PREVIOUS REGIMEN: 1a. DIFFERENT DEPOT from DEPOT‐medium term (3‐12 months)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

CONTINUATION ON PREVIOUS REGIMEN: 1a. DIFFERENT DEPOT from DEPOT‐medium term (3‐12 months)

SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN

Weight: Body weight (kg) ‐ switching to haloperidol decanoate from fluphenazine decanoate
Follow‐up: 12 months

The mean Weight: Body weight (kg) ‐ switching to haloperidol decanoate from fluphenazine decanoate in the intervention groups was
2.8 lower
(7.04 lower to 1.44 higher)

19
(1 study)

⊕⊕⊝⊝
low1,2

Relevant trial but small study. SD estimated rather than reported directly.

Weight: BMI not improved

See comment

See comment

Not estimable

0
(03)

See comment

Outcome of interest ‐ but no study reported this outcome.

Physiological measure: Metabolic syndrome

See comment

See comment

Not estimable

0
(03)

See comment

Outcome of interest ‐ but no study reported this outcome.

Global state: Changing dose because of deterioration ‐ switching to haloperidol decanoate from fluphenazine decanoate
Follow‐up: 12 months

222 per 1000

40 per 1000
(2 to 744)

RR 0.18
(0.01 to 3.35)

19
(1 study)

⊕⊕⊝⊝
low1,2

Stated specific scales were to be used ‐ but no direct data reported form these measures. Criteria for 'deterioration' not explicit

Mental state: Deteriorated ‐ switching to haloperidol decanoate from fluphenazine decanoate
Follow‐up: 12 months

222 per 1000

40 per 1000
(2 to 744)

RR 0.18
(0.01 to 3.35)

19
(1 study)

⊕⊕⊝⊝
low1,2

Stated specific scales were to be used ‐ but no direct data reported form these measures. Criteria for 'deterioration' not explicit

Adverse effects: serious

See comment

See comment

Not estimable

0
(03)

See comment

Outcome of interest ‐ but no study reported this outcome.

Satisfaction with care: Loss to follow up ‐ switching to haloperidol decanoate from fluphenazine decanoate
Follow‐up: 12 months

0 per 1000

0 per 1000
(0 to 0)

RR 4.55
(0.25 to 83.7)

19
(1 study)

⊕⊝⊝⊝
very low1,2,4,5

Small trial. Unclear if loss to follow up really reflects 'satisfaction'.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Randomisation not well described
2 Small study, likely that others are not identified
3 No study reported this finding
4 Loss to follow up not simply measure of satisfaction
5 Wide confidence intervals

Figuras y tablas -
Summary of findings for the main comparison. SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN compared to CONTINUATION ON PREVIOUS REGIMEN: 1a. DIFFERENT DEPOT from DEPOT‐medium term (3‐12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems
Ir a la tabla de la revisión
Summary of findings 2. SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN compared to CONTINUATION ON PREVIOUS REGIMEN: 1b. NEW ATYPICAL from OLANZAPINE ‐ medium term (3‐12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems

SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN compared to CONTINUATION ON PREVIOUS REGIMEN: 1b. NEW ATYPICAL from OLANZAPINE ‐ medium term (3‐12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems

Patient or population: patients with people with schizophrenia who have neuroleptic‐induced weight or metabolic problems
Settings: community
Intervention: SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN
Comparison: CONTINUATION ON PREVIOUS REGIMEN: 1b. NEW ATYPICAL from OLANZAPINE ‐ medium term (3‐12 months)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

CONTINUATION ON PREVIOUS REGIMEN: 1b. NEW ATYPICAL from OLANZAPINE ‐ medium term (3‐12 months)

SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN

Weight: 1. Body weight (kg)

The mean Weight: 1. Body weight (kg) in the intervention groups was
1.94 lower
(3.97 lower to 0.08 higher)

287
(2 studies)

⊕⊕⊝⊝
low1,2,3

Weight: 1. Body weight (kg) ‐ switching to aripiprazole

The mean Weight: 1. Body weight (kg) ‐ switching to aripiprazole in the intervention groups was
3.21 lower
(9.03 lower to 2.61 higher)

158
(1 study)

⊕⊕⊝⊝
low1,3

Weight: 2a. BMI ‐ Increase

Study population

RR 0.28
(0.13 to 0.57)

173
(1 study)

⊕⊝⊝⊝
very low1,4

329 per 1000

92 per 1000
(43 to 188)

Medium risk population

329 per 1000

92 per 1000
(43 to 188)

Physiological measures: 1c. Average fasting glucose change ‐ switching to aripiprazole and quetiapine

The mean Physiological measures: 1c. Average fasting glucose change ‐ switching to aripiprazole and quetiapine in the intervention groups was
2.53 lower
(2.94 to 2.11 lower)

280
(2 studies)

⊕⊕⊝⊝
low1,3

Global state: Relapse

Study population

RR 1.31
(0.55 to 3.11)

133
(1 study)

⊕⊕⊝⊝
low1,3

118 per 1000

155 per 1000
(65 to 367)

Medium risk population

118 per 1000

155 per 1000
(65 to 367)

Adverse events: 1a. Serious adverse event ‐ switching to aripiprazole

Study population

RR 0.64
(0.24 to 1.71)

172
(1 study)

⊕⊕⊝⊝
low1,3

107 per 1000

68 per 1000
(26 to 183)

Medium risk population

107 per 1000

68 per 1000
(26 to 183)

Satisfaction with care: Loss to follow up ‐ switching to aripiprazole

Study population

RR 1.4
(0.89 to 2.21)

173
(1 study)

⊕⊝⊝⊝
very low1,3,5

259 per 1000

363 per 1000
(231 to 572)

Medium risk population

259 per 1000

363 per 1000
(231 to 572)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Randomisation process not described.
2 In one study there were no results from the various scales mentioned in the methods section . This study was terminated early as only 33% of the enrolment target was achieved.
3 Sponsored by interested industry.
4 The study was not published but found in the drug industry's trial register so likely that there are other similar trials which may have been missed.
5 Satisfaction with care alone may not account for all loss to follow up.

Figuras y tablas -
Summary of findings 2. SWITCHING ‐ NEW ANTIPSYCHOTIC REGIMEN compared to CONTINUATION ON PREVIOUS REGIMEN: 1b. NEW ATYPICAL from OLANZAPINE ‐ medium term (3‐12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems
Ir a la tabla de la revisión
Summary of findings 3. SWITCHING ‐ TECHNIQUES: TO ARIPIPRAZOLE from PREVIOUS REGIMEN ‐ THREE DIFFERENT TECHNIQUES ‐short term (up to 12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems

SWITCHING ‐ TECHNIQUES: TO ARIPIPRAZOLE from PREVIOUS REGIMEN ‐ THREE DIFFERENT TECHNIQUES ‐short term (up to 12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems

Patient or population: patients with people with schizophrenia who have neuroleptic‐induced weight or metabolic problems
Settings:
Intervention: SWITCHING ‐ TECHNIQUES: TO ARIPIPRAZOLE from PREVIOUS REGIMEN ‐ THREE DIFFERENT TECHNIQUES ‐short term (up to 12 months)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

SWITCHING ‐ TECHNIQUES: TO ARIPIPRAZOLE from PREVIOUS REGIMEN ‐ THREE DIFFERENT TECHNIQUES ‐short term (up to 12 months)

Weight: Gain‐more than or equal to 7% from baseline

Study population

RR 0.61
(0.15 to 2.47)

207
(1 study)

⊕⊕⊕⊝
moderate1

Switching of treatment in this study may not have been for weight control therefore this client group may differ from those in the other trials in this review

48 per 1000

29 per 1000
(7 to 119)

Medium risk population

48 per 1000

29 per 1000
(7 to 119)

Weight: BMI not improved

See comment

See comment

Not estimable

0
(0)

See comment

Outcome of interest‐but the study did not report this outcome

Physiological measure: Metabolic syndrome

See comment

See comment

Not estimable

0
(0)

See comment

Outcome of interest‐but the study did not report this outcome

Global state: Average change (CGI‐I, high=good)

The mean Global state: Average change (CGI‐I, high=good) in the intervention groups was
0.14 lower
(0.49 lower to 0.21 higher)

203
(1 study)

⊕⊕⊕⊝
moderate1

Mental state: Average change (PANSS, high decline=good)

The mean Mental state: Average change (PANSS, high decline=good) in the intervention groups was
2.52 higher
(2.39 lower to 7.43 higher)

198
(1 study)

⊕⊕⊝⊝
low1,2

Adverse events: Any event

Study population

RR 1
(0.91 to 1.1)

207
(1 study)

⊕⊕⊕⊝
moderate1

894 per 1000

894 per 1000
(814 to 983)

Medium risk population

894 per 1000

894 per 1000
(814 to 983)

Satisfaction with care: Loss to follow up ‐ non‐compliance

Study population

RR 4
(0.45 to 35.19)

208
(1 study)

⊕⊝⊝⊝
very low1,2,3

10 per 1000

40 per 1000
(4 to 352)

Medium risk population

10 per 1000

40 per 1000
(4 to 352)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Sponsored by interested industry.
2 Wide confidence intervals.
3 Satisfaction with care alone may not account for all loss to follow ups.

Figuras y tablas -
Summary of findings 3. SWITCHING ‐ TECHNIQUES: TO ARIPIPRAZOLE from PREVIOUS REGIMEN ‐ THREE DIFFERENT TECHNIQUES ‐short term (up to 12 months) for people with schizophrenia who have neuroleptic‐induced weight or metabolic problems
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Comparison 1. Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight: Body weight (kg) ‐ switching to haloperidol decanoate from fluphenazine decanoate Show forest plot

1

19

Mean Difference (IV, Fixed, 95% CI)

‐2.80 [‐7.04, 1.44]

2 Global state: Changing dose because of deterioration ‐ switching to haloperidol decanoate from fluphenazine decanoate Show forest plot

1

19

Risk Ratio (M‐H, Fixed, 95% CI)

0.18 [0.01, 3.35]

3 Mental state: Deteriorated ‐ switching to haloperidol decanoate from fluphenazine decanoate Show forest plot

1

19

Risk Ratio (M‐H, Fixed, 95% CI)

0.18 [0.01, 3.35]

4 Loss to follow up ‐ switching to haloperidol decanoate from fluphenazine decanoate Show forest plot

1

19

Risk Ratio (M‐H, Fixed, 95% CI)

4.55 [0.25, 83.70]
Figuras y tablas -
Comparison 1. Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1a. different depot from depot ‐ medium term (3‐12 months)
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Comparison 2. Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight: 1. Body weight (kg) Show forest plot

2

287

Mean Difference (IV, Fixed, 95% CI)

‐1.94 [‐3.97, 0.08]

1.1 switching to aripiprazole

1

158

Mean Difference (IV, Fixed, 95% CI)

‐3.21 [‐9.03, 2.61]

1.2 switching to quetiapine

1

129

Mean Difference (IV, Fixed, 95% CI)

‐1.77 [‐3.93, 0.39]

2 Weight: 2a. BMI ‐ increase Show forest plot

1

173

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.13, 0.57]

3 Weight: 2b. BMI ‐ average change Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

‐0.52 [‐1.26, 0.22]

3.1 switching to quetiapine

1

129

Mean Difference (IV, Fixed, 95% CI)

‐0.52 [‐1.26, 0.22]

4 Waist circumference ‐ increase Show forest plot

1

173

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.76, 1.11]

5 Physiological measures: 1a. Average changes ‐ switching to quetiapine Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 lipids ‐ cholesterol levels

1

130

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.23, 0.27]

5.2 lipids ‐ low density lipoproteins

1

130

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.24, 0.20]

5.3 lipids ‐ high density lipoproteins

1

130

Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.05, 0.11]

5.4 lipids ‐ triglyceride

1

130

Mean Difference (IV, Fixed, 95% CI)

0.13 [‐0.18, 0.44]

6 Physiological measures: 1b. Percentage changes ‐ switching to aripiprazole Show forest plot

Other data

No numeric data

6.1 lipids ‐ cholesterol

Other data

No numeric data

6.2 lipids ‐ triglycerides

Other data

No numeric data

6.3 lipids ‐ low density lipoproteins

Other data

No numeric data

6.4 lipids ‐ high density lipoproteins

Other data

No numeric data

7 Physiological measures: 1c. Average changes ‐ sugar Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 fasting insulin level

1

155

Mean Difference (IV, Random, 95% CI)

‐0.3 [‐4.04, 3.44]

7.2 insulin level

1

125

Mean Difference (IV, Random, 95% CI)

8.63 [‐8.82, 26.08]

7.3 c‐peptides

1

153

Mean Difference (IV, Random, 95% CI)

0.36 [‐0.19, 0.91]

7.4 sugar ‐ fasting glucose ‐ switching to aripiprazole and quetiapine

2

280

Mean Difference (IV, Random, 95% CI)

‐2.53 [‐2.94, ‐2.11]

8 Global state: 1a. Relapse Show forest plot

1

133

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.55, 3.11]

9 Global state: 1b. Average change (CGI‐S, high decline = good) ‐ switching to aripiprazole Show forest plot

1

164

Mean Difference (IV, Fixed, 95% CI)

0.29 [‐0.01, 0.59]

10 Mental state: Average change (PANSS, high decline = good) ‐ switching to quetiapine Show forest plot

1

133

Mean Difference (IV, Fixed, 95% CI)

‐3.63 [‐10.31, 3.05]

11 Loss to follow‐up Show forest plot

2

306

Risk Ratio (M‐H, Random, 95% CI)

1.67 [1.22, 2.28]

11.1 switching to aripiprazole

1

173

Risk Ratio (M‐H, Random, 95% CI)

1.40 [0.89, 2.21]

11.2 switching to quetiapine

1

133

Risk Ratio (M‐H, Random, 95% CI)

1.94 [1.27, 2.96]

12 Adverse events: 1. Serious adverse event Show forest plot

2

305

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.48, 2.07]

12.1 switching to aripiprazole

1

172

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.24, 1.71]

12.2 switching to quetiapine

1

133

Risk Ratio (M‐H, Fixed, 95% CI)

1.83 [0.56, 5.96]

13 Adverse events: 2. Treatment emergent adverse events Show forest plot

2

302

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.92, 1.24]

13.1 switching to aripiprazole

1

172

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.92, 1.53]

13.2 switching to quetiapine

1

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.82, 1.14]
Figuras y tablas -
Comparison 2. Switching ‐ new antipsychotic regimen vs continuation on previous regimen: 1b. new atypical from olanzapine ‐ medium term (3‐12 months)
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Comparison 3. Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight: gain (≥ 7% from baseline) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 technique 1 vs technique 2

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.15, 2.47]

1.2 technique 1 vs technique 3

1

205

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.20, 4.79]

1.3 technique 2 vs technique 3

1

206

Risk Ratio (M‐H, Fixed, 95% CI)

1.63 [0.40, 6.66]

2 Global state: 1a. Average change (CGI‐I, high = good) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 technique 1 vs technique 2

1

203

Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.49, 0.21]

2.2 technique 1 vs technique 3

1

203

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.34, 0.36]

2.3 technique 2 vs technique 3

1

204

Mean Difference (IV, Fixed, 95% CI)

0.15 [‐0.20, 0.50]

3 Global state: 1b. Average change (CGI‐S, decline = good) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 technique 1 vs technique 2

1

203

Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐0.27, 0.15]

3.2 technique 1 vs technique 3

1

203

Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.24, 0.16]

3.3 technique 2 vs technique 3

1

204

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.20, 0.24]

4 Mental state: Average change (PANSS, high decline = good) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 technique 1 vs technique 2

1

197

Mean Difference (IV, Fixed, 95% CI)

0.59 [‐4.51, 5.69]

4.2 technique 1 vs technique 3

1

198

Mean Difference (IV, Fixed, 95% CI)

2.52 [‐2.39, 7.43]

4.3 technique 2 vs technique 3

1

201

Mean Difference (IV, Fixed, 95% CI)

1.93 [‐2.63, 6.49]

5 Loss to follow up: 1a. Any reason Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 technique 1 vs technique 2

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.87, 1.26]

5.2 technique 1 vs technique 3

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.73, 1.01]

5.3 technique 2 vs technique 3

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.70, 0.97]

6 Loss to follow‐up: 1b. Various specific reasons Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 technique 1 vs technique 2 ‐ adverse events

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.23, 1.59]

6.2 technique 1 vs technique 2 ‐ worsening illness

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.43, 2.30]

6.3 technique 1 vs technique 2 ‐ withdrew consent

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.24, 1.42]

6.4 technique 1 vs technique 2 ‐ non‐compliance

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

4.0 [0.45, 35.19]

6.5 technique 1 vs technique 2 ‐ other (lost to follow‐up, protocol violation and patient met withdrawal criteria)

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

2.5 [0.50, 12.60]

6.6 technique 1 vs technique 3 ‐ adverse events

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.33, 2.97]

6.7 technique 1 vs technique 3 ‐ worsening illness

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.51, 3.01]

6.8 technique 1 vs technique 3 ‐ withdrew consent

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

6.93 [0.87, 55.35]

6.9 technique 1 vs technique 3 ‐ non‐compliance

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

3.96 [0.45, 34.85]

6.10 technique 1 vs technique 3 ‐ other (lost to follow‐up, protocol violation, patient met withdrawal criteria)

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.34, 4.48]

6.11 technique 2 vs technique 3 ‐ adverse events

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

1.65 [0.62, 4.38]

6.12 technique 2 vs technique 3 ‐ worsening illness

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.51, 3.01]

6.13 technique 2 vs technique 3 ‐ withdrew consent

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

11.88 [1.57, 89.74]

6.14 technique 2 vs technique 3 ‐ non‐compliance

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.06, 15.62]

6.15 technique 2 vs technique 3 ‐ other (lost to follow‐up, protocol violation, patient met withdrawal criteria)

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.09, 2.64]

7 Adverse events: Any event Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 technique 1 vs technique 2

1

207

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.91, 1.10]

7.2 technique 1 vs technique 3

1

205

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.98, 1.23]

7.3 technique 2 vs technique 3

1

208

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [1.00, 1.26]
Figuras y tablas -
Comparison 3. Switching ‐ techniques: to aripriprazole from previous regimen ‐ three dfferent techniques ‐ short term (up to 12 months)
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