Clorpromazina versus metiapina para la esquizofrenia
Información
- DOI:
- https://doi.org/10.1002/14651858.CD011655.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 25 marzo 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Esquizofrenia
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
MZ: developed the protocol, selected trials, extracted and analysed data, and wrote the review.
AB: developed the protocol, selected trials, extracted and analysed data, and wrote the review.
Sources of support
Internal sources
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Kerman University of Medical Sciences, Kerman, Iran.
Authors are students at this university
External sources
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None, Other.
Declarations of interest
MZ has no declarations of interest.
AB has no declarations of interest.
Acknowledgements
The Cochrane Schizophrenia Group Editorial Base in Nottingham, UK produces and maintains standard text for use in the Methods section of their reviews. We have used this text as the basis of what appears here and adapted it as required.
The search term was developed by the Trials Search Co‐ordinator of the Cochrane Schizophrenia Group and the contact author of this review.
Parts of this review were generated using RevMan HAL v 4.0 (RevMan5).
We would also like to thank Chak Fa Ma, Dan Bressington, Maolin Du and Eyal Dahan for peer reviewing this version of the review.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Mar 25 | Chlorpromazine versus metiapine for schizophrenia | Review | Morteza Zare, Azam Bazrafshan | |
| 2015 May 06 | Chlorpromazine versus metiapine for schizophrenia | Protocol | Morteza Zare, Azam Bazrafshan, Maryam Okhovati, Shahrzad Mazhari, Ruzbe Mousavi | |
Differences between protocol and review
We clarified which adverse effect was of interest ‐ as the other reviews within this family of chlorpromazine comparisons have presented movement disorder data and due to chlorpromazine's known risk of causing movement disorders we felt this should be the adverse effect we presented for our review. We have also changed the wording of some outcomes from 'clinically significant' to 'clinically important'.
We have changed the text in 'why it is important to do this review' to clarify why it is important to compare these two antipsychotic drugs and so the text is similar to the other reviews in this series of chlorpromazine comparisons (Table 1).
We have added a sentence to the methods to clarify use of subscales
'(c) the instrument should be a global assessment of an area of functioning and not subscores which are not, in themselves, validated or shown to be reliable. However, there are exceptions, we will include subscores from mental state scales measuring positive and negative symptoms of schizophrenia'.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Antipsychotic Agents [adverse effects, *therapeutic use];
- Chlorpromazine [adverse effects, *therapeutic use];
- Dibenzothiazepines [adverse effects, *therapeutic use];
- Parkinson Disease, Secondary [chemically induced];
- Randomized Controlled Trials as Topic;
- Schizophrenia [*drug therapy];
- Treatment Outcome;
Medical Subject Headings Check Words
Adult; Humans;
PICO
Chlorpromazine ‐ structure.
Metiapine structure.
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 1 Global state: 1. Clinically important improvement (CGI, high = poor)).
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 2 Global state: 2a. Overall: remaining symptomatic.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 3 Global state: 2b. Overall: mean endpoint score (NOSIE, high = poor).
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 4 Adverse effects: 1. General: "severe reactions".
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 5 Adverse effects: 2a. Specific: central nervous system ‐ drowsiness.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 6 Adverse effects: 2b. Specific: hepatic ‐ abnormal liver function test.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 7 Adverse effects: 2c. Specific: movement disorders.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 8 Adverse effects: 2d. Specific: others.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 9 Leaving the study.
Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 10 Service utilisation: staying in hospital.
| Methods | Allocation: randomised, with sequence generation and concealment of allocation clearly described. |
| Participants | Diagnosis: people with schizophrenia ‐ however diagnosed.* |
| Interventions | 1. Metiapine: about 200 mg/day. n = 150. |
| Outcomes | Global state ‐ relapse, clinically important change. Mental state ‐ general ‐ clinically important change in mental state, mean change in negative symptoms. Adverse effects ‐ incidence of serious adverse events/effects, clinically important extrapyramidal symptoms. Leaving the study early ‐ for any reason. Cost of care. Service outcomes: admitted, number of admissions, length of hospitalisation, discharge, contacts with psychiatric services. Compliance with drugs. Economic evaluations: cost‐effectiveness, cost‐benefit. |
| Notes | * This could be diagnosed by clinical decision. If funds were permitting all participants could be screened using operational criteria, otherwise a random sample should suffice. ** Size of study with sufficient power to highlight about a 10% difference between groups for primary outcome. |
| n: number of participants. | |
| Chlorpromazine versus metiapine for schizophrenia | ||||||
| Patient or population: people with schizophrenia | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Chlorpromazine | Metiapine | |||||
| Global state: clinically important improvement | 600 per 1000 | 684 per 1000 | RR 1.11 | 120 | ⊕⊝⊝⊝ | 1 trial reported CGI at 4 weeks, and 1 trial reported CGI at 6 weeks' follow‐up, both indicated no significant difference between the 2 drugs. |
| Mental state: clinically important improvement | No studies reported this outcome. | |||||
| Adverse effects. Specific: movement disorders ‐ parkinsonism | 168 per 1000 | 144 per 1000 | RR 0.97 | 70 | ⊕⊝⊝⊝ | ‐ |
| Service use: readmission due to relapse | No studies reported on these outcomes. | |||||
| Satisfaction of participant or care provider with treatment | ||||||
| Behaviour: aggressive or violent behaviour | ||||||
| Cost of care | ||||||
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Risk of bias: serious (downgraded by 1 level): study had unclear risk of other biases as supported by a pharmaceutical company for drug supply. | ||||||
| Review title | Reference |
| Acetophenazine versus chlorpromazine for schizophrenia. | |
| Chlorpromazine dose for people with schizophrenia. | |
| Cessation of medication for people with schizophrenia already stable on chlorpromazine. | |
| Chlorpromazine versus atypical antipsychotic drugs for schizophrenia. | |
| Chlorpromazine versus clotiapine for schizophrenia. | |
| Chlorpromazine versus metiapine for schizophrenia. | This review |
| Chlorpromazine versus penfluridol for schizophrenia. | |
| Chlorpromazine versus piperacetazine for schizophrenia. | |
| Chlorpromazine versus placebo for schizophrenia. | |
| Chlorpromazine for psychosis induced aggression or agitation. | |
| Haloperidol versus chlorpromazine for schizophrenia. | |
| * | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Global state: 1. Clinically important improvement (CGI, high = poor)) Show forest plot | 2 | 120 | Risk Ratio (M‐H, Random, 95% CI) | 1.11 [0.84, 1.47] |
| 2 Global state: 2a. Overall: remaining symptomatic Show forest plot | 1 | 10 | Risk Difference (M‐H, Random, 95% CI) | 0.0 [‐0.31, 0.31] |
| 3 Global state: 2b. Overall: mean endpoint score (NOSIE, high = poor) Show forest plot | 1 | 60 | Mean Difference (IV, Random, 95% CI) | 0.20 [‐3.49, 3.89] |
| 4 Adverse effects: 1. General: "severe reactions" Show forest plot | 3 | 140 | Risk Ratio (M‐H, Random, 95% CI) | 0.79 [0.41, 1.49] |
| 5 Adverse effects: 2a. Specific: central nervous system ‐ drowsiness Show forest plot | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 1.0 [0.15, 6.64] |
| 6 Adverse effects: 2b. Specific: hepatic ‐ abnormal liver function test Show forest plot | 2 | 120 | Risk Ratio (M‐H, Random, 95% CI) | 1.35 [0.17, 10.75] |
| 7 Adverse effects: 2c. Specific: movement disorders Show forest plot | 3 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 7.1 Akathisia | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 1.0 [0.32, 3.10] |
| 7.2 Dystonic symptoms | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 5.0 [0.25, 99.95] |
| 7.3 Parkinsonism | 2 | 70 | Risk Ratio (M‐H, Random, 95% CI) | 0.97 [0.46, 2.03] |
| 7.4 Rigidity | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 0.63 [0.23, 1.69] |
| 7.5 Tremor | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 0.33 [0.01, 7.87] |
| 7.6 Use of anti‐parkinson or other remedial medication | 1 | 10 | Risk Ratio (M‐H, Random, 95% CI) | 1.22 [0.73, 2.06] |
| 8 Adverse effects: 2d. Specific: others Show forest plot | 3 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 8.1 Autonomic ‐ blurred vision | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 5.0 [0.25, 99.95] |
| 8.2 Cardiovascular (heart) problem | 3 | 130 | Risk Ratio (M‐H, Random, 95% CI) | 0.52 [0.09, 3.08] |
| 8.3 Ophthalmological ‐ "eye changes" | 1 | 10 | Risk Ratio (M‐H, Random, 95% CI) | 0.0 [0.0, 0.0] |
| 9 Leaving the study Show forest plot | 2 | 70 | Risk Ratio (M‐H, Random, 95% CI) | 0.33 [0.01, 7.87] |
| 10 Service utilisation: staying in hospital Show forest plot | 1 | 60 | Risk Ratio (M‐H, Random, 95% CI) | 1.05 [0.74, 1.48] |
