Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis

meta-analysis

Crossley, Nicolas A. MRCPsych, MSc
Constante, Miguel MRCPsych
McGuire, Philip FRCPsych, PhD
Power, Paddy MRCPsych, FRANZCP, MD

Division of Psychological Medicine, Institute of Psychiatry, London (Crossley) (Constante)
Division of Psychological Medicine, Institute of Psychiatry, and Outreach and Support in South London (OASIS), South London and Maudsley NHS Foundation Trust, London (McGuire)
Division of Psychological Medicine, Institute of Psychiatry, and Lambeth Early Onset Services (LEO), South London and Maudsley NHS Foundation Trust, London, UK (Power)

Correspondence: Nicolas A. Crossley, Division of Psychological Medicine, Institute of Psychiatry PO 67, De Crespigny Park, London SE5 8AF. Email: [email protected]

Declaration of interest

None.

First received 17 Mar 2009, final revision 2 Dec 2009, accepted 17 Feb 2010

British Journal of Psychiatry 196(6):p 434-439, June 2010.

Background

There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.

Aims

To examine the evidence base for this recommendation.

Method

Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.

Results

Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = −0.1, 95% CI −0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = −0.4, 95% CI −0.5 to −0.2).

Conclusions

There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.