Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials

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Yildiz A., Vieta E., Leucht S., Baldessarini R. J.

NEUROPSYCHOPHARMACOLOGY, cilt.36, sa.2, ss.375-389, 2011 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 36 Sayı: 2
  • Basım Tarihi: 2011
  • Doi Numarası: 10.1038/npp.2010.192
  • Dergi Adı: NEUROPSYCHOPHARMACOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.375-389
  • Anahtar Kelimeler: antimanic, antipsychotic, mania, mood stabilizer, placebo, PLACEBO-CONTROLLED TRIAL, ACUTE BIPOLAR MANIA, RELEASE CARBAMAZEPINE CAPSULES, SODIUM EXTENDED-RELEASE, DOUBLE-BLIND TRIAL, I-DISORDER, DIVALPROEX SODIUM, MIXED EPISODES, ARIPIPRAZOLE MONOTHERAPY, RISPERIDONE MONOTHERAPY
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

We conducted meta-analyses of findings from randomized, placebo-controlled, short-term trials for acute mania in manic or mixed states of DSM (III-IV) bipolar I disorder in 56 drug-placebo comparisons of 17 agents from 38 studies involving 10 800 patients. Of drugs tested, 13 (76%) were more effective than placebo: aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperdone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone. Their pooled effect size for mania improvement (Hedges' g in 48 trials) was 0.42 (confidence interval (CI): 0.36-0.48); pooled responder risk ratio (46 trials) was 1.52 (CI: 1.42-1.62); responder rate difference (RD) was 17% (drug: 48%, placebo: 31%), yielding an estimated number-needed-to-treat of 6 (all p<0.0001). In several direct comparisons, responses to various antipsychotics were somewhat greater or more rapid than lithium, valproate, or carbamazepine; lithium did not differ from valproate, nor did second generation antipsychotics differ from haloperidol. Meta-regression associated higher study site counts, as well as subject number with greater placebo (not drug) response; and higher baseline mania score with greater drug (not placebo) response. Most effective agents had moderate effect-sizes (Hedges' g=0.26-0.46); limited data indicated large effect sizes (Hedges' g=0.51-2.32) for: carbamazepine, cariprazine, haloperidol, risperidone, and tamoxifen. The findings support the efficacy of most clinically used antimanic treatments, but encourage more head-to-head studies and development of agents with even greater efficacy. Neuropsychopharmacology (2011) 36, 375-389; doi:10.1038/npp.2010.192; published online 27 October 2010