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Review
. 2010 Jun;196(6):434-9.
doi: 10.1192/bjp.bp.109.066217.

Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

Nicolas A Crossley  1 , Miguel Constante, Philip McGuire, Paddy Power
Affiliations
Review

Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

Nicolas A Crossley et al. Br J Psychiatry. 2010 Jun.

Abstract

Background: There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.

Aims: To examine the evidence base for this recommendation.

Method: Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.

Results: Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = -0.1, 95% CI -0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = -0.4, 95% CI -0.5 to -0.2).

Conclusions: There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

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Figures

Fig. 1
Fig. 1
Flowchart of study selection. RCT, randomised controlled study.
Fig. 2
Fig. 2
Comparison of discontinuation rates among participants receiving first- v. second-generation antipsychotics. P = 0.22. Heterogeneity χ2 = 28.55 (d.f. = 6) P<0.001, I2 = 79.0%. EPGN, Early Psychosis Global Network; GRNS, German Research Network on Schizophrenia; EUFEST, European First-Episode Schizophrenia Trial. For clarity purposes, the first author of the first published paper is used in Table DS1 in cases where more than one article reporting outcomes of the study has been included.
Fig. 3
Fig. 3
Comparisons of symptoms scales at short term (around 3 months) between the two groups. Effect sizes were standardised using Hedges’ g and pooled using a random-effects model. Non-significant difference favouring atypicals shown (P = 0.12). Heterogeneity χ2 = 15.3 (d.f. = 11) P = 0.17, I2 = 28%. EPGN, Early Psychosis Global Network; GRNS, German Research Network on Schizophrenia; EUFEST, European First-Episode Schizophrenia Trial.
Fig. 4
Fig. 4
Comparison of weight gain between the two groups. Data expressed in kilograms, and pooled using random-effects model. Significant weight gain found in atypical group (P = 0.04). Heterogeneity χ2 = 29.79 (d.f. = 6) P<0.001, I2 = 79.9%. EPGN, Early Psychosis Global Network; GRNS, German Research Network on Schizophrenia; EUFEST, European First-Episode Schizophrenia Trial.
Fig. 5
Fig. 5
Extrapyramidal side-effects in both groups using standardised mean differences. A highly significant difference favouring atypicals was found (P<0.001). Note that all individual trials favour atypicals. Heterogeneity χ2 = 12.3 (d.f. = 8) P = 0.14, I2 = 35%. EPGN, Early Psychosis Global Network; GRNS, German Research Network on Schizophrenia; EUFEST, European First-Episode Schizophrenia Trial.
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Comment in

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