Antipsychotic drugs barbiturates or benzodiazepines used as active placebos for schizophrenia: a systematic review and meta-analysis.
Title | Antipsychotic drugs barbiturates or benzodiazepines used as active placebos for schizophrenia: a systematic review and meta-analysis. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Siafis, S., Deste G., Ceraso A., Mussoni C., Vita A., Hasanagic S., Schneider-Thoma J., Papazisis G., Davis J. M., & Leucht S. |
Journal | Psychol Med |
Pagination | 1-12 |
Date Published | 2019 Oct 18 |
ISSN | 1469-8978 |
Abstract | BACKGROUND: Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.METHODS: Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).RESULTS: Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a 'good' response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36-3.41; I2 = 48.9) and 'any' response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35-3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on 'any' response (74.7% v. 65%; RR 1.15; 95% CI 0.82-1.62).CONCLUSIONS: Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants. |
DOI | 10.1017/S003329171900285X |
Alternate Journal | Psychol Med |
PubMed ID | 31625485 |