Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Topics

Temas

Chlorpromazine ‐ structure.
Figuras y tablas -
Figure 1

Chlorpromazine ‐ structure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Metiapine structure.
Figuras y tablas -
Figure 2

Metiapine structure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study flow diagram.
Figuras y tablas -
Figure 3

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 4

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 5

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 1 Global state: 1. Clinically important improvement (CGI, high = poor)).
Figuras y tablas -
Analysis 1.1

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 1 Global state: 1. Clinically important improvement (CGI, high = poor)).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 2 Global state: 2a. Overall: remaining symptomatic.
Figuras y tablas -
Analysis 1.2

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 2 Global state: 2a. Overall: remaining symptomatic.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 3 Global state: 2b. Overall: mean endpoint score (NOSIE, high = poor).
Figuras y tablas -
Analysis 1.3

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 3 Global state: 2b. Overall: mean endpoint score (NOSIE, high = poor).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 4 Adverse effects: 1. General: "severe reactions".
Figuras y tablas -
Analysis 1.4

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 4 Adverse effects: 1. General: "severe reactions".

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 5 Adverse effects: 2a. Specific: central nervous system ‐ drowsiness.
Figuras y tablas -
Analysis 1.5

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 5 Adverse effects: 2a. Specific: central nervous system ‐ drowsiness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 6 Adverse effects: 2b. Specific: hepatic ‐ abnormal liver function test.
Figuras y tablas -
Analysis 1.6

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 6 Adverse effects: 2b. Specific: hepatic ‐ abnormal liver function test.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 7 Adverse effects: 2c. Specific: movement disorders.
Figuras y tablas -
Analysis 1.7

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 7 Adverse effects: 2c. Specific: movement disorders.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 8 Adverse effects: 2d. Specific: others.
Figuras y tablas -
Analysis 1.8

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 8 Adverse effects: 2d. Specific: others.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 9 Leaving the study.
Figuras y tablas -
Analysis 1.9

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 9 Leaving the study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 10 Service utilisation: staying in hospital.
Figuras y tablas -
Analysis 1.10

Comparison 1 CHLORPROMAZINE versus METIAPINE (all data short term), Outcome 10 Service utilisation: staying in hospital.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Table 2. Suggestions for design of future study

Methods

Allocation: randomised, with sequence generation and concealment of allocation clearly described.
Blindness: double, tested.
Duration: ≥ 12 months beyond end of intervention.
Raters: independent.

Participants

Diagnosis: people with schizophrenia ‐ however diagnosed.*
Age: any.
Sex: both.
History: any.
n = 300.**

Interventions

1. Metiapine: about 200 mg/day. n = 150.
2. Chlorpromazine: about 400 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.
Figuras y tablas -
Table 2. Suggestions for design of future study
Ir a la tabla de la revisión
Summary of findings for the main comparison. Chlorpromazine versus metiapine for schizophrenia

Chlorpromazine versus metiapine for schizophrenia

Patient or population: people with schizophrenia
Settings: hospital
Intervention: chlorpromazine
Comparison: metiapine

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Chlorpromazine

Metiapine

Global state: clinically important improvement
Clinical Global Impression
Follow‐up: mean 5 weeks

600 per 1000

684 per 1000
(522 to 894)

RR 1.11
(0.84 to 1.47)

120
(2 studies)

⊕⊝⊝⊝
Very low1,2,3

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
Follow‐up: 8 weeks

168 per 1000

144 per 1000
(89 to 233)

RR 0.97
(0.46 to 2.03)

70
(2 studies)

⊕⊝⊝⊝
Very low1,2,3

‐

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).
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 Risk of bias: serious (downgraded by 1 level): study had unclear risk of other biases as supported by a pharmaceutical company for drug supply.
2 Risk of bias: serious (downgraded by 1 level): studies had unclear risk of bias for allocation concealment and blinding outcome assessment.
3 Imprecision: serious (downgraded by 1 level): total sample size was very small.

Figuras y tablas -
Summary of findings for the main comparison. Chlorpromazine versus metiapine for schizophrenia
Ir a la tabla de la revisión
Table 1. The Cochrane Reviews/protocols relevant to chlorpromazine for people with schizophrenia

Review title

Reference

Acetophenazine versus chlorpromazine for schizophrenia.

Bazrafshan 2015

Chlorpromazine dose for people with schizophrenia.

Liu 2009

Cessation of medication for people with schizophrenia already stable on chlorpromazine.

Almerie 2007

Chlorpromazine versus atypical antipsychotic drugs for schizophrenia.

Saha 2013

Chlorpromazine versus clotiapine for schizophrenia.

Mazhari 2015

Chlorpromazine versus metiapine for schizophrenia.

This review

Chlorpromazine versus penfluridol for schizophrenia.

Khalili 2015

Chlorpromazine versus piperacetazine for schizophrenia.

Eslami 2015

Chlorpromazine versus placebo for schizophrenia.

Adams 2014

Chlorpromazine for psychosis induced aggression or agitation.

Ahmed 2010

Haloperidol versus chlorpromazine for schizophrenia.

Leucht 2008

*
Figuras y tablas -
Table 1. The Cochrane Reviews/protocols relevant to chlorpromazine for people with schizophrenia
Ir a la tabla de la revisión
Comparison 1. CHLORPROMAZINE versus METIAPINE (all data short term)

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]
Figuras y tablas -
Comparison 1. CHLORPROMAZINE versus METIAPINE (all data short term)
Ir a la tabla de la revisión