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European Psychiatry
Volume 21, n° 1
pages 11-20 (janvier 2006)
Doi : 10.1016/j.eurpsy.2005.09.009
Received : 10 November 2004 ;  accepted : 13 September 2005
Meta-analysis of drop-out rates in randomised clinical trials, comparing typical and atypical antipsychotics in the treatment of schizophrenia
 

José Luis R. Martin a, b, ⁎ , Víctor Pérez c, Montse Sacristán a, Fernando Rodríguez-Artalejo d, Cristóbal Martínez e, Enric Álvarez c
a Department of Clinical Research, Castilla-La Mancha Health Research Foundation (FISCAM), Edificio Bulevar, C/Berna, No. 2, Local 0-2, 45003 Toledo, Castilla-La Mancha, Spain 
b University of Castilla-La Mancha, Toledo, Spain 
c Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain 
d Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain 
e Department of Clinical Pharmacology, Alarcos Hospital, Ciudad Real, Spain 

*Corresponding author. Tel.: +34 92528 1144; fax: +34 92528 1149.

Submitted to European Psychiatry. A poster of this work was presented at the WPA International Congress in Florence (November 10–13, 2004). Poster session PO1: Psychotic Disorders

Abstract

Objective. – To assess antipsychotic medication in the treatment of schizophrenia, based on trial drop-out rates.

Method. – The studies included were randomised controlled trials that compared any of the four clinically best-established atypical antipsychotics (quetiapine, olanzapine, risperidone or clozapine) against either of two typical antipsychotics regarded as the gold standard (haloperidol or chlorpromazine).

Results. – Meta-analysis indicated less risk of all-cause patient withdrawal from atypical medication trials where dosage was flexible, in both the short, relative risk (RR) 0.70 (95% CI 0.64–0.76), P <0.00001, and long term, RR 0.72 (0.65–0.80), P <0.00001. Similar results were observed for withdrawal due to adverse events, RR: 0.54 (0.41–0.72), P <0.0001. Nevertheless, the favourable effects of atypical medication disappeared in trials relying on fixed dosage.

Conclusions. – We detected a significant positive effect in terms of the outcome of treatment discontinuation for atypical versus typical medication, though only where the use of flexible rather than fixed doses (closer to an experimental control situation) was possible.


Keywords : Systematic review, Meta-analysis, Schizophrenia, Clinical trials


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