Researchers conducted a network meta-analysis of placebo-controlled and head-to-head randomized controlled trials to compare more than 30 antipsychotics, utilizing Embase, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform, and more. The analysis is the largest network meta-analysis done in the field of schizophrenia. It was based on 402 studies, including 463 participants randomly assigned to different older and newer antipsychotics or placebo.

The researchers state that the findings will aid clinicians to balance risks vs benefits of drugs available in their countries. They should consider the importance of each outcome, the patients’ medical problems, and preferences. Excluded were studies in patients with treatment resistance, first episode, predominant negative or depressive symptoms, concomitant medical illnesses, and relapse-prevention studies.

While antipsychotic drugs are the treatment of choice for adults with multi-episode schizophrenia, controversy surrounds what agent should be used. Differences in efficacy do exist between antipsychotics, but most of them are gradual rather than discrete, and differences in side-effects are more marked.

Reference: Huhn, M, Nikolakopoulou, A, Schneider-Thoma, J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394(10202):939-951. doi:10.1016/S0140-6736(19)31135-3