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Meta-Analysis
. 2014 Jul 8;2014(7):CD009396.
doi: 10.1002/14651858.CD009396.pub2.

Trifluoperazine versus low-potency first-generation antipsychotic drugs for schizophrenia

Magdolna Tardy  1 , Markus Dold, Rolf R Engel, Stefan Leucht
Affiliations
Meta-Analysis

Trifluoperazine versus low-potency first-generation antipsychotic drugs for schizophrenia

Magdolna Tardy et al. Cochrane Database Syst Rev. .

Abstract

Background: Antipsychotic drugs are the core treatment for schizophrenia. Treatment guidelines state that there is no difference in efficacy between any other antipsychotic compounds, however, low-potency antipsychotic drugs are often perceived as less efficacious than high-potency compounds by clinicians, and they also seem to differ in their side-effects.

Objectives: To review the effects in response to treatment of trifluoperazine and low-potency antipsychotics for people with schizophrenia.

Search methods: We searched the Cochrane Schizophrenia Group's Trials Register (November 2010).

Selection criteria: We included all randomised trials comparing trifluoperazine with first-generation low-potency antipsychotic drugs for people with schizophrenia or schizophrenia-like psychosis.

Data collection and analysis: We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model.

Main results: The review currently includes seven randomised trials involving 422 participants that compared trifluoperazine with low-potency antipsychotic drugs. The size of the included studies was between 20 and 157 participants with a study length between four and 52 weeks. Overall, sequence generation, allocation procedures and blinding were poorly reported. Trifluoperazine was not significantly different from low-potency antipsychotic drugs in terms of response to treatment (trifluoperazine 26%, low-potency drug 27%, 3 RCTs, n = 120, RR 0.96 CI 0.59 to 1.56, moderate quality evidence). There was also no significant difference in acceptability of treatment with equivocal number of participants leaving the studies early due to any reason (trifluoperazine 20%, low-potency antipsychotics 16%, 3 RCTs, n = 239, RR 1.25, CI 0.72 to 2.17,low quality evidence). There was no significant difference in numbers with at least one adverse effect (trifluoperazine 60%, low-potency antipsychotics 38%, 1 RCT, n = 60, RR 1.60, CI 0.94 to 2.74, moderate quality evidence). However, at least one movement disorder was significantly more frequent in the trifluoperazine group (trifluoperazine 23%, low-potency antipsychotics 13%, 2 RCTs, n = 123, RR 2.08 CI 0.78 to 5.55, very low quality evidence) as well as incoordination (trifluoperazine 20%, low-potency antipsychotics 5%, 1 RCT, n = 60, RR 7.00, CI 1.60 to 30.66) and rigor (trifluoperazine 45%, low-potency antipsychotics 10%, 1 RCT, n = 60, RR 4.50, CI 1.58 to 12.84). No data were available for other outcomes of interest death, sedation and quality of life.

Authors' conclusions: The results did not show a difference in efficacy between trifluoperazine and low-potency antipsychotics. Trifluoperazine produced more movement disorders. The number of randomised studies as well as their quality is low, the quality of evidence for outcomes of interest ranged from moderate to very low quality, so more, newer studies would be needed for conclusions about the relative effects of trifluoperazine and low-potency antipsychotics.

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Conflict of interest statement

Magdolna Tardy ‐ none to declare.

Markus Dold ‐ none to declare.

Rolf Engel ‐ none to declare.

Stefan Leucht ‐ has received honoraria for lectures from Abbvie, Astra Zeneca, BristolMyersSquibb, ICON, EliLilly, Janssen, Johnson & Johnson, Roche, SanofiAventis, Lundbeck and Pfizer; honoraria for consulting/advisory boards from Roche, EliLilly, Medavante, BristolMyersSquibb, Alkermes, Janssen, Johnson & Johnson and Lundbeck. EliLilly has provided medication for a study with SL as primary investigator.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 1 Response to treatment ‐ medium term.
1.2
1.2. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 2 Leaving the study early: 1. Acceptability of treatment ‐ leaving early due to any reason.
1.3
1.3. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 3 Leaving the study early: 2. Due to adverse effects.
1.4
1.4. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 4 Leaving the study early: 3. Due to inefficacy.
1.5
1.5. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 5 Relapse.
1.6
1.6. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 6 Adverse events: 1. General ‐ at least one adverse effect.
1.7
1.7. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 7 Adverse events: 2.a. Specific ‐ movement disorders.
1.8
1.8. Analysis
Comparison 1 Comparison 1: TRIFLUOPERAZINE versus LOW‐POTENCY ANTIPSYCHOTIC DRUGS, Outcome 8 Adverse effects: 2.b. Specific ‐ others.
2.1
2.1. Analysis
Comparison 2 Subgroup analysis, Outcome 1 Response to treatment ‐ each low‐potency antipsychotic separately.
2.2
2.2. Analysis
Comparison 2 Subgroup analysis, Outcome 2 Response to treatment ‐ treatment resistance.
3.1
3.1. Analysis
Comparison 3 Sensitivity analysis, Outcome 1 Response to treatment ‐ fixed effects model.
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