Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis.

Krause, Marc; Zhu, Yikang; Huhn, Maximilian; Schneider-Thoma, Johannes; Bighelli, Irene; Nikolakopoulou, Adriani; Leucht, Stefan (2018). Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis. European archives of psychiatry and clinical neuroscience, 268(7), pp. 625-639. Springer 10.1007/s00406-018-0869-3

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BACKGROUND

Negative symptoms are the core of schizophrenia, but whether antipsychotics are efficacious for their treatment is unclear. Moreover, there is debate whether patients in relevant trials should have predominant negative symptoms or whether prominent negative symptoms are also acceptable.

METHODS

We systematically reviewed randomised, blinded antipsychotic drug trials in patients with schizophrenia and either predominant or prominent negative symptoms (last search Dec 12, 2017). Separate pairwise meta-analyses were conducted in these two populations. The primary outcome was negative symptoms. Depressive, symptoms, positive symptoms, and extrapyramidal side-effects were analysed as causes of secondary negative symptoms.

FINDINGS

We included 21 randomized-controlled trials with 3451 participants which revealed the following significant differences in the primary outcome: in patients with predominant negative symptoms amisulpride was superior to placebo (N = 4; n = 590, SMD 0.47, CI 0.23, 0.71), olanzapine was superior to haloperidol in a small trial (n = 35) and cariprazine outperformed risperidone (N = 1, n = 456, SMD - 0.29, CI - 0.48, - 0.11). In patients with prominent negative symptoms, olanzapine and quetiapine were superior to risperidone in single trials. Overall, studies in prominent negative symptoms were potentially more confounded by improvements of secondary negative symptoms.

INTERPRETATION

Amisulpride is the only antipsychotic that outperformed placebo in the treatment of predominant negative symptoms, but there was a parallel reduction of depression. Cariprazine was better than risperidone in a large trial that was well-controlled for secondary negative symptoms, but the trial was sponsored by its manufacturer. Future trials should apply scientifically developed definitions such as the deficit syndrome and the persistent negative symptoms concept.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Nikolakopoulou, Adriani

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0940-1334

Publisher:

Springer

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

08 Feb 2018 15:51

Last Modified:

02 May 2022 11:28

Publisher DOI:

10.1007/s00406-018-0869-3

PubMed ID:

29368205

Uncontrolled Keywords:

Deficit schizophrenia Deficit syndrome Depressive symptoms Persistent negative symptoms Positive symptoms Study design

BORIS DOI:

10.7892/boris.110770

URI:

https://boris.unibe.ch/id/eprint/110770

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