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Meta-Analysis
. 2013 May 31;2013(5):CD007815.
doi: 10.1002/14651858.CD007815.pub2.

Quetiapine versus typical antipsychotic medications for schizophrenia

Sirijit Suttajit  1 , Manit Srisurapanont, Jun Xia, Siritree Suttajit, Benchalak Maneeton, Narong Maneeton
Affiliations
Meta-Analysis

Quetiapine versus typical antipsychotic medications for schizophrenia

Sirijit Suttajit et al. Cochrane Database Syst Rev. .

Abstract

Background: Quetiapine is a widely used atypical antipsychotic drug for schizophrenia that has been on the market for over a decade. However, It is not clear how the effects of quetiapine differ from typical antipsychotics.

Objectives: To review the effects of quetiapine in comparison with typical antipsychotics in the treatment of schizophrenia and schizophrenia-like psychosis.

Search methods: We searched the Cochrane Schizophrenia Group Trials Register (March 2010), and inspected references of all identified studies.

Selection criteria: We included all randomised control trials comparing oral quetiapine with typical antipsychotic drugs in people with schizophrenia or schizophrenia-like psychosis.

Data collection and analysis: We extracted data independently. For dichotomous data, we calculated risk ratio (RR) and 95% confidence intervals (CI) using a random-effects model. We presented chosen outcomes in a 'Summary of findings' table and comparative risks where appropriate. For continuous data, we calculated mean differences (MD) based on a random-effects model. We assessed risk of bias for included studies.

Main results: The review includes 43 randomised controlled trials (RCTs) with 7217 participants. Most studies were from China. The percentages of participants leaving the studies early were similar (36.5% in quetiapine group and 36.9% in typical antipsychotics group) and no significant difference between groups was apparent for leaving early due to any reason (23 RCTs n = 3576 RR 0.91 CI 0.81 to 1.01, moderate quality evidence), however, fewer participants in the quetiapine group left the studies early due to adverse events (15 RCTs, n = 3010, RR 0.48 CI 0.30 to 0.77).Overall global state was similar between groups (no clinically significant response; 16 RCTs, n = 1607, RR 0.96 CI 0.75 to 1.23, moderate quality evidence) and there was no significant difference in positive symptoms (PANSS positive subscore: 22 RCTs, n = 1934, MD 0.02 CI -0.39 to 0.43, moderate quality evidence). General psychopathology was equivocal (PANSS general psychopathology subscore: 18 RCTs, n = 1569, MD -0.20 CI -0.83 to 0.42) between those allocated to quetiapine and typical antipsychotics. However, quetiapine was statistically significantly more efficacious for negative symptoms (PANSS negative subscore: 22 RCTs, n = 1934, MD -0.82 CI -1.59 to -0.04, moderate quality evidence), however, this result was highly heterogeneous and driven by two small outlier studies with high effect sizes. Without these two studies, there was no heterogeneity and no statistically significant difference between quetiapine and typical antipsychotics.Compared with typical antipsychotics, quetiapine might cause fewer adverse effects (9 RCTs, n = 1985, RR 0.76 CI 0.64 to 0.90 number needed to treat to induce harm (NNTH) 10, CI 8 to 17), less abnormal ECG (2 RCTs, n = 165, RR 0.38 CI 0.16 to 0.92, NNTH 8, CI 4 to 55), fewer overall extrapyramidal effects (8 RCTs, n = 1,095, RR 0.17 CI 0.09 to 0.32, NNTH 3, CI 3 to 3, moderate quality evidence) and fewer specific extrapyramidal effects including akathisia, parkinsonism, dystonia and tremor. Moreover, it might cause lower prolactin level (4 RCTs, n = 1034, MD -16.20 CI -23.34 to -9.07, moderate quality evidence) and less weight gain compared with some typical antipsychotics in the short term (9 RCTs, n = 866, RR 0.52 CI 0.34 to 0.80, NNTH 8, CI 6 to 15).However, there was no significant difference between the two groups in suicide attempt, suicide, death, QTc prolongation, low blood pressure, tachycardia, sedation, gynaecomastia, galactorrhoea, menstrual irregularity and white blood cell count.

Authors' conclusions: Quetiapine may not differ from typical antipsychotics in the treatment of positive symptoms and general psychopathology. There are no clear differences in terms of the treatment of negative symptoms. However, it causes fewer adverse effects in terms of abnormal ECG, extrapyramidal effects, abnormal prolactin levels and weight gain.

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Conflict of interest statement

Sirijit Suttajit and Manit Srisurapanont received support for attending national and international scientific meetings from AstraZeneca (Thailand), Eli Lilly Asia, Inc. (Thailand), GlaxoSmithKline (Thailand), Janssen‐Cilag (Thailand) and Servier (Thailand).

Benchalak Maneeton and Narong Maneeton received similar supports for attending national scientific meetings from GlaxoSmithKline (Thailand) and Janssen‐Cilag (Thailand).

Jun Xia and Siritree Suttajit: none known.

Figures

1
1
PRISMA flow diagram.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 1 Global state: 1. No clinical improvement.
1.2
1.2. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 2 Global state: 2a. CGI: Average CGI‐S (high = poor).
1.3
1.3. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 3 Global state: 2b. CGI: Average endpoint CGI‐I (high = poor).
1.4
1.4. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 4 Leaving the study early: 1. Any reason.
1.5
1.5. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 5 Leaving the study early: 2. Adverse events.
1.6
1.6. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 6 Leaving the study early: 3. Inefficacy.
1.7
1.7. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 7 Mental state: 1a. General ‐ average score (PANSS total, high = poor).
1.8
1.8. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 8 Mental state: 1b. General ‐ average score ‐short term (BPRS total, high = poor).
1.9
1.9. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 9 Mental state: 2a. Positive symptoms ‐ average endpoint score (PANSS positive subscore, high = poor).
1.10
1.10. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 10 Mental state: 2b. Positive symptoms ‐ average score ‐ short term (BPRS positive subscore, high = poor).
1.11
1.11. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 11 Mental state: 3a. Negative symptoms ‐ average endpoint score (PANSS negative subscore, high = poor).
1.12
1.12. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 12 Mental state: 3b. Negative symptoms ‐ average score ‐ short term (BPRS negative subscore, high = poor)).
1.13
1.13. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 13 Mental state: 3c. Negative symptoms ‐ average score ‐ short term (SANS total, high = poor).
1.14
1.14. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 14 Mental state: 4. General psychopathology ‐ average endpoint score (PANSS general psychopathology subscore, high = poor).
1.15
1.15. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 15 General functioning: General ‐ average endpoint score ‐ long term (GAF total score, low = poor).
1.16
1.16. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 16 Quality of life: 1a. General ‐ average endpoint score ‐short term (SF‐36, low = poor).
1.17
1.17. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 17 Quality of life: 1b. General ‐ average endpoint score ‐ long term (MANSA total score, low = poor).
1.18
1.18. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 18 Quality of life: 1c. General ‐ average change score ‐ long term (QLS, high = poor).
1.19
1.19. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 19 Cognitive function: 1a. General ‐ average change score ‐ long term (Composite score, high = poor).
1.20
1.20. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 20 Cognitive function: 1b. General ‐ average endpoint scores as defined by the original studies (low = poor).
1.21
1.21. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 21 Service use: number of participants re‐hospitalised ‐ long term.
1.22
1.22. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 22 Adverse effects: 1. General ‐ at least one adverse effect.
1.23
1.23. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 23 Adverse effects: 2. Death.
1.24
1.24. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 24 Adverse effects: 3a. Cardiac effects ‐ QTc prolongation ‐ long term.
1.25
1.25. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 25 Adverse effects: 3b. Cardiac effects ‐ abnormal ECG ‐ short term.
1.26
1.26. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 26 Adverse effects: 3c. Cardiac effects ‐ orthostatic hypotension.
1.27
1.27. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 27 Adverse effects: 3d. Cardiac effects ‐ low blood pressure ‐ short term.
1.28
1.28. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 28 Adverse effects: 3e. Cardiac effects ‐ tachycardia ‐ short term.
1.29
1.29. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 29 Adverse effects: 4. Central nervous system ‐ sedation.
1.30
1.30. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 30 Adverse effects: 5a. Extrapyramidal effects ‐ overall ‐ short term.
1.31
1.31. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 31 Adverse effects: 5b. Extrapyramidal effects ‐ akathisia.
1.32
1.32. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 32 Adverse effects: 5c. Extrapyramidal effects ‐ parkinsonism.
1.33
1.33. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 33 Adverse effects: 5d. Extrapyramidal effects ‐ dystonia.
1.34
1.34. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 34 Adverse effects: 5e. Extrapyramidal effects ‐ tremor ‐ short term.
1.35
1.35. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 35 Adverse effects: 5f. Extrapyramidal effects ‐ scale measured (dichotomous data) ‐ long term.
1.36
1.36. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 36 Adverse effects: 5g. Extrapyramidal effects ‐ scale measured (continuous data, high=poor).
1.37
1.37. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 37 Adverse effects: 6a. Prolactin associated side effects.
1.38
1.38. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 38 Adverse effects: 6b. Prolactin ‐ Hyperprolactinemia.
1.39
1.39. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 39 Adverse effects: 6c. Prolactin level ‐ average level in ng/mL.
1.40
1.40. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 40 Adverse effects: 7a. Weight gain (as defined by the original studies).
1.41
1.41. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 41 Adverse effects: 7b. Weight gain ‐ average weight in kg..
1.42
1.42. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 42 Adverse effects: 8. decreased white blood cell count ‐ short term.
1.43
1.43. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 43 Sensitivity analysis (skewed data excluded), Mental state: 1. General ‐ average endpoint score (PANSS total, high = poor).
1.44
1.44. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 44 Sensitivity analysis (skewed data excluded), Mental state: 2. Negative symptoms ‐ average endpoint score (PANSS negative subscore, high=poor) ‐ medium term.
1.45
1.45. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 45 Sensitivity analysis (inappropriate comparator doses excluded), Mental state: 1: General‐ average endpoint score (PANSS total, high=poor).
1.46
1.46. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 46 Sensitivity analysis (inappropriate comparator doses excluded), Mental state: 2: Positive symptoms‐ average endpoint score (PANSS positive subscore, high = poor).
1.47
1.47. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 47 Sensitivity analysis (inappropriate comparator doses excluded), Mental state: 3: Negative symptoms‐ average endpoint score (PANSS negative subscore, high = poor).
1.48
1.48. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 48 Senstivity analysis (high attrition rate data excluded), Mental state: 1: General ‐ average score (PANSS total, high = poor).
1.49
1.49. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 49 Sensitivity analysis (high attrition rate data excluded), Mental state: 2. Positive symptoms ‐ average endpoint score (PANSS positive subscore, high = poor).
1.50
1.50. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 50 Sensitivity analysis (high attrition rate data excluded), Mental state: 3. Negative symptoms ‐ average endpoint score (PANSS negative subscore, high = poor).
1.51
1.51. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 51 Senstivity analysis (completer data only), Mental state: 1: General ‐ average score (PANSS total, high=poor).
1.52
1.52. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 52 Sensitivity analysis (completer data only), Mental state: 2. Positive symptoms ‐ average endpoint score (PANSS positive subscore, high = poor).
1.53
1.53. Analysis
Comparison 1 QUETIAPINE versus TYPICAL ANTIPSYCHOTICS, Outcome 53 Sensitivity analysis (completer data only), Mental state: 3. Negative symptoms ‐ average endpoint score (PANSS negative subscore, high = poor).
See this image and copyright information in PMC

Update of

References

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vs PERPHEN ‐ Yi 2006 {published data only}
    1. Yi QM, Fan WL, Chen ZQ. The contrast investigation between quetiapine and perphenazlne in the treatment of first episode of schizophrenia in children. Journal of the North Sichuan Medical College 2006;2(6):522‐4.

References to studies excluded from this review

Buckley 2001 {published data only}
    1. Buckley PF. Comparison of the effects of quetiapine and haloperidol in a cohort of patients with treatment resistant schizophrenia. Schizophrenia Research 2001;49(1,2):221.
Cheng 2003 {published data only}
    1. Cheng XF. Control observation of quetiapine vs chlorpromazine in schizophrenia. Journal of Clinical Psychosomatic Diseases 2003;9(2):78‐80.
Du 2004 {published data only}
    1. Du QX, Yu CF, Zhong W. A clinical comparative analysis of quetiapine and chlorpromazine in treatment of schizophrenia. Medical Journal of Chinese Peoples Health 2004;16(7):398‐9.
Glick 2005 {published data only}
    1. Glick ID, Marder SR. Long‐term maintenance therapy with quetiapine versus haloperidol decanoate in patients with schizophrenia or schizoaffective disorder. Journal of Clinical Psychiatry 2005;66(5):638‐41. - PubMed
Goldstein 1999 {published data only}
    1. Goldstein J, Emsley R, Raniwalla J, Bailey P, Jones M. Efficacy and tolerability of quetiapine compared with haloperidol in schizophrenic patients partially responsive to conventional antipsychotic treatment. Proceedings of the 39th Annual Meeting of the New Clinical Drug Evaluation Unit; 1999 Jun 1‐4; Boca Raton, Florida, USA. Boca Raton, Florida, USA., 1999.
Grecu 2006 {published data only}
    1. Grecu G, Grecu GM, Pop M. Clinical effectiveness of atypical vs typical antipsychotics in treatment of schizophrenia patients. Proceedings of the 19th European College of Neuropsychopharmacology Congress; 2006 Sep 16‐20; Paris, France. Paris, France, 2006.
Guo 2006 {published data only}
    1. Guo XF, Zhao JP, Chen JD, Zhang ZC. The effect of chlorpromazine and quetiapine on serum lipid and glucose. Journal of Clinical Psychological Medicine 2006;16(5):257‐9.
Hammond 2001 {published data only}
    1. Hammond R, Bustillo J, Lauriello J, Keith SJ, Nadiga D. Efficacy of quetiapine in antipsychotic naïve patients. Schizophrenia Research 2001;49(1,2):231.
Jones 2006 {published data only}
    1. Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on quality of life of second‐ vs first‐generation antipsychotic drugs in schizophrenia. Cost Utility of the latest antipsychotic drugs in schizophrenia study (CUtLASS 1). Archives of General Psychiatry 2006;63:1079‐87. - PubMed
Keleman 2006 {published data only}
    1. Kelemen O, Nagy O, Máttyássy A, Kiss I, Janka Z, Kéri S. Do second‐generation antipsychotics disrupt decision‐making abilities in schizophrenia?. European Neuropsychopharmacology 2006;16(Suppl 4):S430.
Kelly 2005 {published data only}
    1. Kelly DL, Conley RR. Thyroid function in treatment‐resistant schizophrenia patients treated with quetiapine, risperidone, or fluphenazine. Journal of Clinical Psychiatry 2005;66(1):80‐4. - PubMed
Kelly 2006 {published data only}
    1. Kelly DL, Conley RR. A randomized double‐blind 12‐week study of quetiapine, risperidone or fluphenazine on sexual functioning in people with schizophrenia. Psychoneuroendocrinology 2006;31(3):340‐6. - PubMed
Kong 2003 {published data only}
    1. Kong DL, Zhang SQ, Shu MQ. Effects of quetiapine and chlorpromazine on serum prolactin of schizophrenics. Journal of Clinical Psychosomatic Diseases 2003; Vol. 9, issue 4:200‐1.
Lee 2001 {published data only}
    1. Lee M, Meltzer HY. Quetiapine is significantly superior to haloperidol and placebo in improving mood in patients with schizophrenia. Proceedings of the 7th World Congress of Biological Psychiatry; 2001 Jul 1‐6; Berlin, Germany. Berlin, Germany, 2001.
Loza 2001 {published data only}
    1. Loza B, Kucharska‐Pietura K, Debowska G. Atypical versus typical antipsychotic treatment prognosis in first‐episode paranoid schizophrenia based on WCST and dichotic listening scores. European Neuropsychopharmacology 2001;11(3):285.
Ma 2004 {published data only}
    1. Ma ZW, Li MX, Shi YZ, Wang LH. Quetipine (35 patients) vs chlorpromazine (34 patients) in treatment of schizophrenia. Chinese Journal of New Drugs and Clinical Remedies 2004; Vol. 23, issue 5:273‐5.
Nai 2007 {published data only}
    1. Nai X, Hu X, Qiu S. Effect of quetiapine on cognition function of patients with first episode schizophrenia. Journal of Medical Forum 2007;28(2):38‐9.
Qiu 2003 {published data only}
    1. Qiu Y, Ma L. A comparative study between quetiapine and haloperidol on the life quality of the patients with schizophrenia. Shandong Archives of Psychiatry 2003;7489(3):138‐40.
Reveley 2001 {unpublished data only}
    1. Reveley M. Seroquel Outcome Study (SOS): a multicentre double‐blind randomised trial to compare the effects of seroquel and chlorpromazine on treatment outcome of schizophrenic patients. National Research Register 2001.
Richardson 2005 {published data only}
    1. Richardson CM, Kelly DL, Gold JM, McMahon R, Yu Y, Conley RR. Risperidone vs quetiapine vs fluphenazine in treatment ‐ resistant schizophrenia: neuropsychological outcome. Schizophrenia Bulletin. 2005; Vol. 31:501‐2.
Sharma 2002 {published data only}
    1. Sharma T. A multi‐centre, double‐blind, randomised trial to compare the effects of "seroquel" and haloperidol in schizophrenic patients with a history of partial response to antipsychotic treatment. National Research Register 2001.
Zhang 2007 {published data only}
    1. Zhang L. A comparative study of quetiapine and chlorpromazine in the treatment of schizophrenia. Modern Medicine Journal of China 2007;9(2):97‐8.

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