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Review
. 2019 Oct;49(14):2307-2319.
doi: 10.1017/S0033291719001995. Epub 2019 Aug 23.

An update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis

N Çakici  1   2 , N J M van Beveren  2   3   4 , G Judge-Hundal  2   5 , M M Koola  6 , I E C Sommer  5
Affiliations
Review

An update on the efficacy of anti-inflammatory agents for patients with schizophrenia: a meta-analysis

N Çakici et al. Psychol Med. 2019 Oct.

Abstract

Background: Accumulating evidence shows that a propensity towards a pro-inflammatory status in the brain plays an important role in schizophrenia. Anti-inflammatory drugs might compensate this propensity. This study provides an update regarding the efficacy of agents with some anti-inflammatory actions for schizophrenia symptoms tested in randomized controlled trials (RCTs).

Methods: PubMed, Embase, the National Institutes of Health website (http://www.clinicaltrials.gov), and the Cochrane Database of Systematic Reviews were systematically searched for RCTs that investigated clinical outcomes.

Results: Our search yielded 56 studies that provided information on the efficacy of the following components on symptom severity: aspirin, bexarotene, celecoxib, davunetide, dextromethorphan, estrogens, fatty acids, melatonin, minocycline, N-acetylcysteine (NAC), pioglitazone, piracetam, pregnenolone, statins, varenicline, and withania somnifera extract. The results of aspirin [mean weighted effect size (ES): 0.30; n = 270; 95% CI (CI) 0.06-0.54], estrogens (ES: 0.78; n = 723; CI 0.36-1.19), minocycline (ES: 0.40; n = 946; CI 0.11-0.68), and NAC (ES: 1.00; n = 442; CI 0.60-1.41) were significant in meta-analysis of at least two studies. Subgroup analysis yielded larger positive effects for first-episode psychosis (FEP) or early-phase schizophrenia studies. Bexarotene, celecoxib, davunetide, dextromethorphan, fatty acids, pregnenolone, statins, and varenicline showed no significant effect.

Conclusions: Some, but not all agents with anti-inflammatory properties showed efficacy. Effective agents were aspirin, estrogens, minocycline, and NAC. We observed greater beneficial results on symptom severity in FEP or early-phase schizophrenia.

Keywords: Add-on antipsychotic therapy; N-acetylcysteine; estrogens; fatty acids; minocycline.

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Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram of the performed literature search.
Fig. 2.
Fig. 2.
Forest Plot Showing Effect Sizes for Anti-Inflammatory Therapies in Schizophrenia.
See this image and copyright information in PMC

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