Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
BASTA-Bündnis für psychisch erkrankte Menschen, Munich, Germany.
Syst Rev. 2023 Mar 24;12(1):54. doi: 10.1186/s13643-023-02213-5.
There is evidence that antipsychotic drugs differ in their effect on the cognitive symptoms of schizophrenia. So far, there is no comprehensive systematic review available that would enable providers and patients to make informed choices regarding this important aspect of treatment. With a large number of substances available, conventional pairwise meta-analyses will not be sufficient to inform this choice. To fill this gap, we will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomized controlled trials (RCTs) to rank antipsychotics according to their effect on cognitive functioning.
In our NMA, we will include RCTs in patients with schizophrenia or schizophrenia-like psychoses comparing one antipsychotic agent with another antipsychotic agent or placebo that measures cognitive function. We will include studies on patients of every age group, in any phase of illness (e.g., acute or stable, first episode or chronic schizophrenia, in- or outpatients) with an intervention time of at least 3 weeks. The primary outcome will be the composite score of cognitive functioning, preferentially measured with the test battery developed by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. The secondary outcomes include the seven cognitive domains that the composite score is composed of, as well as functioning and quality of life. Study selection and data extraction will be conducted by at least two independent reviewers. We will use the Cochrane Risk of Bias tool 2 to determine the risk of bias in studies, and we will evaluate the confidence in the results using Confidence in Network Meta-Analysis (CINeMA). We will perform NMA using R (package netmeta). We will conduct subgroup and sensitivity analyses to explore the heterogeneity and assess the robustness of our findings.
This systematic review and network meta-analysis aims to inform evidence-based antipsychotic treatment choice for cognitive deficits in schizophrenia patients by analyzing existing RCTs on this subject. The results have the potential to support patients' and physicians' decision-making processes based on the latest available evidence.
PROSPERO CRD42022312483.
有证据表明，抗精神病药物在治疗精神分裂症认知症状方面存在差异。到目前为止，还没有全面的系统评价可以使提供者和患者能够就治疗的这一重要方面做出明智的选择。由于有大量的药物可供选择，传统的两两荟萃分析将不足以提供这种选择。为了填补这一空白，我们将进行一项网络荟萃分析（NMA），整合来自随机对照试验（RCT）的直接和间接比较，根据认知功能对各种抗精神病药物进行排名。
在我们的 NMA 中，我们将包括 RCT，这些 RCT 比较了一种抗精神病药物与另一种抗精神病药物或安慰剂在精神分裂症或类似精神分裂症的精神病患者中的疗效，这些 RCT 测量了认知功能。我们将包括各个年龄段的患者，处于疾病的任何阶段（例如，急性或稳定期，首发或慢性精神分裂症，门诊或住院患者），干预时间至少为 3 周。主要结局将是认知功能的综合评分，优先使用由 Measurement and Treatment Research to Improve Cognition in Schizophrenia（MATRICS）倡议开发的测试组合进行测量。次要结局包括复合评分由其组成的七个认知领域，以及功能和生活质量。研究选择和数据提取将由至少两名独立审查员进行。我们将使用 Cochrane 风险偏倚工具 2 来确定研究中的风险偏倚，并使用置信网络荟萃分析（CINeMA）来评估结果的置信度。我们将使用 R（netmeta 包）进行 NMA。我们将进行亚组和敏感性分析，以探索异质性并评估我们发现的稳健性。
这项系统评价和网络荟萃分析旨在通过分析现有关于该主题的 RCT，为精神分裂症患者认知缺陷的循证抗精神病治疗选择提供信息。这些结果有可能根据最新的可用证据为患者和医生的决策过程提供支持。
PROSPERO CRD42022312483。
