COMPARATIVE EFFICACY AND TOLERABILITY OF 15 ANTIPSYCHOTIC DRUGS IN SCHIZOPHRENIA: A MULTIPLE-TREATMENTS META-ANALYSIS
We aimed to integrate the available evidence to create hierarchies of the comparative efficacy, risk of all-cause discontinuation, and major side-effects of antipsychotic drugs. We did a multiple-treatments meta-analysis (which uses both direct and indirect comparisons) of randomised controlled trials to compare 15 antipsychotic drugs. Blinded, randomised controlled trials of patients with schizophrenia or related disorders were eligible. The primary outcome was efficacy. We also examined all-cause discontinuation, weight gain, extrapyramidal side-effects, prolactin increase, QTc prolongation, and sedation. We identified 212 suitable trials, with data for 43 049 participants. Our findings challenge the straightforward classification of antipsychotics into first-generation and second- generation groupings. Rather, hierarchies in the different domains should help clinicians to adapt the choice of antipsychotic drug to the needs of individual patients. These findings should be considered by mental health policy makers and in the revision of clinical practice guidelines.