Suttajit Sirijit, Srisurapanont Manit, Xia Jun, Suttajit Siritree, Maneeton Benchalak, Maneeton Narong
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Cochrane Database Syst Rev. 2013 May 31;2013(5):CD007815. doi: 10.1002/14651858.CD007815.pub2.
Quetiapine is a widely used atypical antipsychotic drug for schizophrenia that has been on the market for over a decade. However, It is not clear how the effects of quetiapine differ from typical antipsychotics.
To review the effects of quetiapine in comparison with typical antipsychotics in the treatment of schizophrenia and schizophrenia-like psychosis.
We searched the Cochrane Schizophrenia Group Trials Register (March 2010), and inspected references of all identified studies.
We included all randomised control trials comparing oral quetiapine with typical antipsychotic drugs in people with schizophrenia or schizophrenia-like psychosis.
We extracted data independently. For dichotomous data, we calculated risk ratio (RR) and 95% confidence intervals (CI) using a random-effects model. We presented chosen outcomes in a 'Summary of findings' table and comparative risks where appropriate. For continuous data, we calculated mean differences (MD) based on a random-effects model. We assessed risk of bias for included studies.
The review includes 43 randomised controlled trials (RCTs) with 7217 participants. Most studies were from China. The percentages of participants leaving the studies early were similar (36.5% in quetiapine group and 36.9% in typical antipsychotics group) and no significant difference between groups was apparent for leaving early due to any reason (23 RCTs n = 3576 RR 0.91 CI 0.81 to 1.01, moderate quality evidence), however, fewer participants in the quetiapine group left the studies early due to adverse events (15 RCTs, n = 3010, RR 0.48 CI 0.30 to 0.77).Overall global state was similar between groups (no clinically significant response; 16 RCTs, n = 1607, RR 0.96 CI 0.75 to 1.23, moderate quality evidence) and there was no significant difference in positive symptoms (PANSS positive subscore: 22 RCTs, n = 1934, MD 0.02 CI -0.39 to 0.43, moderate quality evidence). General psychopathology was equivocal (PANSS general psychopathology subscore: 18 RCTs, n = 1569, MD -0.20 CI -0.83 to 0.42) between those allocated to quetiapine and typical antipsychotics. However, quetiapine was statistically significantly more efficacious for negative symptoms (PANSS negative subscore: 22 RCTs, n = 1934, MD -0.82 CI -1.59 to -0.04, moderate quality evidence), however, this result was highly heterogeneous and driven by two small outlier studies with high effect sizes. Without these two studies, there was no heterogeneity and no statistically significant difference between quetiapine and typical antipsychotics.Compared with typical antipsychotics, quetiapine might cause fewer adverse effects (9 RCTs, n = 1985, RR 0.76 CI 0.64 to 0.90 number needed to treat to induce harm (NNTH) 10, CI 8 to 17), less abnormal ECG (2 RCTs, n = 165, RR 0.38 CI 0.16 to 0.92, NNTH 8, CI 4 to 55), fewer overall extrapyramidal effects (8 RCTs, n = 1,095, RR 0.17 CI 0.09 to 0.32, NNTH 3, CI 3 to 3, moderate quality evidence) and fewer specific extrapyramidal effects including akathisia, parkinsonism, dystonia and tremor. Moreover, it might cause lower prolactin level (4 RCTs, n = 1034, MD -16.20 CI -23.34 to -9.07, moderate quality evidence) and less weight gain compared with some typical antipsychotics in the short term (9 RCTs, n = 866, RR 0.52 CI 0.34 to 0.80, NNTH 8, CI 6 to 15).However, there was no significant difference between the two groups in suicide attempt, suicide, death, QTc prolongation, low blood pressure, tachycardia, sedation, gynaecomastia, galactorrhoea, menstrual irregularity and white blood cell count.
AUTHORS' CONCLUSIONS: Quetiapine may not differ from typical antipsychotics in the treatment of positive symptoms and general psychopathology. There are no clear differences in terms of the treatment of negative symptoms. However, it causes fewer adverse effects in terms of abnormal ECG, extrapyramidal effects, abnormal prolactin levels and weight gain.
喹硫平是一种广泛用于治疗精神分裂症的非典型抗精神病药物，已上市十多年。然而，喹硫平与典型抗精神病药物的疗效差异尚不清楚。
比较喹硫平与典型抗精神病药物治疗精神分裂症及精神分裂症样精神病的效果。
我们检索了Cochrane精神分裂症研究组试验注册库（2010年3月），并查阅了所有已识别研究的参考文献。
我们纳入了所有比较口服喹硫平与典型抗精神病药物治疗精神分裂症或精神分裂症样精神病患者的随机对照试验。
我们独立提取数据。对于二分数据，我们使用随机效应模型计算风险比（RR）和95%置信区间（CI）。我们在“结果总结”表中呈现选定的结果，并在适当情况下呈现比较风险。对于连续数据，我们基于随机效应模型计算平均差（MD）。我们评估了纳入研究的偏倚风险。
该综述纳入了43项随机对照试验（RCT），共7217名参与者。大多数研究来自中国。提前退出研究的参与者百分比相似（喹硫平组为36.5%，典型抗精神病药物组为36.9%），且因任何原因提前退出的两组之间无明显差异（23项RCT，n = 3576，RR 0.91，CI 0.81至1.01，中等质量证据），然而，喹硫平组因不良事件提前退出研究的参与者较少（15项RCT，n = 3010，RR 0.48，CI 0.30至0.77）。两组的总体全球状态相似（无临床显著反应；16项RCT，n = 1607，RR 0.96，CI 0.75至1.23，中等质量证据），阳性症状无显著差异（阳性和阴性症状量表（PANSS）阳性子量表：22项RCT，n = 1934，MD 0.02，CI -0.39至0.43，中等质量证据）。在分配接受喹硫平与典型抗精神病药物治疗的患者之间，一般精神病理学情况不明确（PANSS一般精神病理学子量表：18项RCT，n = 1569，MD -0.20，CI -0.83至0.42）。然而，喹硫平对阴性症状的疗效在统计学上显著更优（PANSS阴性子量表：22项RCT，n = 1934，MD -0.82，CI -1.59至-0.04，中等质量证据），然而，该结果高度异质性，由两项效应量高的小的异常值研究驱动。排除这两项研究后，喹硫平与典型抗精神病药物之间无异质性且无统计学显著差异。与典型抗精神病药物相比，喹硫平可能引起的不良反应较少（9项RCT，n = 1985，RR 0.76，CI 0.64至0.90，伤害需治人数（NNTH）10，CI 8至17），较少出现心电图异常（2项RCT，n = 165，RR 0.38，CI 0.16至0.92，NNTH 8，CI 4至55），较少出现总体锥体外系反应（8项RCT，n = 1095，RR 0.17，CI 0.09至0.32，NNTH 3，CI 3至3，中等质量证据）以及较少出现包括静坐不能、帕金森症、肌张力障碍和震颤在内的特定锥体外系反应。此外，与一些典型抗精神病药物相比，它可能导致较低的催乳素水平（4项RCT，n = 1034，MD -16.20，CI -23.34至-9.07，中等质量证据），且短期内体重增加较少（9项RCT，n = 866，RR 0.52，CI 0.34至0.80，NNTH 8，CI 6至15）。然而，两组在自杀未遂、自杀、死亡、QTc延长、低血压、心动过速、镇静、男性乳房发育、溢乳、月经不调和白细胞计数方面无显著差异。
喹硫平在治疗阳性症状和一般精神病理学方面可能与典型抗精神病药物无差异。在阴性症状治疗方面无明显差异。然而，在心电图异常、锥体外系反应、催乳素水平异常和体重增加方面，它引起的不良反应较少。
