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. 2014 Sep 1;2014(9):CD009227.
doi: 10.1002/14651858.CD009227.pub2.

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

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

Flupenthixol 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 antipsychotic drugs, however, low-potency antipsychotic drugs are sometimes 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 clinical response of flupenthixol and low-potency antipsychotics for people with schizophrenia.

Search methods: We searched the Cochrane Schizophrenia Group Trials Register (July 2010).

Selection criteria: Randomised controlled trials that compared flupenthixol with first-generation low-potency antipsychotic drugs for people with schizophrenia or schizophrenia-like psychosis.

Data collection and analysis: We extracted data independently. For continuous data, we calculated mean differences (MD) based on a random-effects model.

Main results: The review currently includes one randomised trial from mainland China with 153 participants that lasted two months and compared flupenthixol with chlorpromazine. The exact methods of sequence generation and allocation concealment were not reported, and medication was provided in an open manner. There were no data on the outcomes that we had a priori selected for a 'Summary of findings' table.There was no significant difference between flupenthixol and chlorpromazine in the participants' general mental state at endpoint as measured by the Brief Psychiatric Rating Scale (BPRS) total score (1 randomised controlled trial (RCT), n = 153, MD 2.20 95% confidence interval (CI) -1.25 to 5.65). Chlorpromazine was associated with significantly less dizziness (1 RCT, n = 153, MD 0.12 95% CI 0.01 to 0.23); dystonia (1 RCT, n = 153, MD 0.29 95% CI 0.13 to 0.45); unsteady gait (1 RCT, n = 153, MD 0.46 95% CI 0.28 to 0.64); reduced facial expression (1 RCT, n = 153, MD 0.27 95% CI 0.09 to 0.45); restlessness (1 RCT, n = 153, MD 0.69 95% CI 0.45 to 0.93); rigidity (elbow) (1 RCT, n = 153, MD 0.48 95% CI 0.28 to 0.68); and tremor (1 RCT, n = 153, MD 0.56 95% CI 0.34 to 0.78). Chlorpromazine produced more dryness of mouth than flupenthixol (1 RCT, n = 153, MD -0.14 95% CI -0.25 to -0.03).

Authors' conclusions: The evidence base of flupenthixol versus low-potency first-generation antipsychotics is currently restricted to one randomised comparison with chlorpromazine. The few reported data do not suggest a difference in efficacy, but flupenthixol appeared to produce more movement disorders and dizziness, while chlorpromazine was associated with the anticholinergic side effect - dryness of mouth. More trials are needed to make conclusions about the relative effects of flupenthixol 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: 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 FLUPENTHIXOL versus LOW‐POTENCY ANTIPSYCHOTICS, Outcome 1 Mental state: General ‐ average total score (BPRS, endpoint, high = poor).
1.2
1.2. Analysis
Comparison 1 FLUPENTHIXOL versus LOW‐POTENCY ANTIPSYCHOTICS, Outcome 2 Adverse effects: 1. Specific ‐ movement disorders (SAS change, high = worse).
1.3
1.3. Analysis
Comparison 1 FLUPENTHIXOL versus LOW‐POTENCY ANTIPSYCHOTICS, Outcome 3 Adverse effects: 2. Specific ‐ other (TESS change, high = worse).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009227

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