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Meta-Analysis
. 2011 Jul;37(4):788-99.
doi: 10.1093/schbul/sbp149. Epub 2009 Nov 27.

Low dose vs standard dose of antipsychotics for relapse prevention in schizophrenia: meta-analysis

Hiroyuki Uchida  1 , Takefumi Suzuki, Hiroyoshi Takeuchi, Tamara Arenovich, David C Mamo
Affiliations
Meta-Analysis

Low dose vs standard dose of antipsychotics for relapse prevention in schizophrenia: meta-analysis

Hiroyuki Uchida et al. Schizophr Bull. 2011 Jul.

Abstract

Background: It remains unknown as to whether the antipsychotic dose needed for the acute-phase treatment of schizophrenia is also necessary for relapse prevention.

Aim: To compare the efficacy between standard dose [(World Health Organization daily defined dose (DDD)] vs low dose (≥50% to <1 DDD) or very low dose (<50% DDD) for relapse prevention in schizophrenia.

Data source: Double-blind, randomized, controlled trials with a follow-up duration of ≥24 weeks, including ≥2 dosage groups of the same antipsychotic drug for relapse prevention in schizophrenia, were searched using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE (last search: August 2009).

Data extraction: Data on overall treatment failure, hospitalization, relapse, and dropouts due to side effects were extracted and combined in a meta-analysis.

Data synthesis: Thirteen studies with 1395 subjects were included in this meta-analysis. Compared with the standard-dose treatment, the low-dose therapy did not show any statistically significant difference in overall treatment failure or hospitalization, while the standard dose showed a trend-level (P = .05) superiority in risk of relapse. The very low-dose group was inferior to the standard-dose group in all efficacy parameters. No significant difference was found in the rate of dropouts due to side effects between either standard dose vs low dose or very low dose.

Conclusions: Although antipsychotic treatment with ≥50% to <1 DDD may be as effective as standard-dose therapy, there are insufficient clinical trial data to draw firm conclusions on standard- vs low-dose maintenance antipsychotic therapy for schizophrenia.

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Figures

Fig. 1.
Fig. 1.
Flowchart of Literature Search.
Fig. 2.
Fig. 2.
Risk of Overall Treatment Failure. SGA: second-generation antipsychotic; FGA: first-generation antipsychotic; CI: confidence interval.
Fig. 3.
Fig. 3.
Risk of Hospitalization. SGA: second-generation antipsychotic; FGA: first-generation antipsychotic; CI: confidence interval.
Fig. 4.
Fig. 4.
Risk of Relapse. SGA: second-generation antipsychotic; FGA: first-generation antipsychotic; CI: confidence interval.
Fig. 5.
Fig. 5.
Risk of Dropout due to Side Effects. SGA: second-generation antipsychotic; FGA: first-generation antipsychotic; CI: confidence interval.
Fig. 6.
Fig. 6.
Comparison of Low Dose and Very Low Dose. CI: confidence of interval.
See this image and copyright information in PMC

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