Ziprasidone for schizophrenia and severe mental illness

 

Abstract

Background

Typical antipsychotic drugs are widely used as the first line treatment for people with schizophrenia. However, the atypical class of antipsychotic drugs are making important inroads into this approach. Atypical is a widely used term used to describe some antipsychotics which have a low propensity to produce movement disorders and raise serum prolactin. There is some suggestion that the different adverse effect profiles of atypical antipsychotic group make them more acceptable to people with schizophrenia. Ziprasidone is one of the newer atypicals with a high serotonin receptor affinity.

Objectives

To determine the effects of ziprasidone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses.

Search methods

Electronic searches of Biological Abstracts (1980-1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1996), PSYNDEX (1977-1999) and PsycLIT (1974-1999) were undertaken. In addition, pharmaceutical databases on the Dialog Corporation Datastar and Dialog services were searched. References of all identified studies were searched for further trials. Pharmaceutical companies (Pfizer - the manufacturer of ziprasidone - and the manufacturers of all comparator drugs) and first authors of all included trials were contacted.

Selection criteria

All randomised controlled trials that compared ziprasidone to other treatments for schizophrenia and schizophrenia-like psychoses were included by independent assessment.

Data collection and analysis

Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted.

Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the risk ratio (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity.

Main results

Data for this compound range from very short (one week) studies of the intramuscular preparation, to trials lasting over six months. For measures of mental state ziprasidone seems more effective than placebo (RR 0.8 CI 0.7-0.9) and as effective as haloperidol (RR 0.8 CI 0.7-1). It is less likely than haloperidol to cause movement disorders (RR 0.4 CI 0.2-0.6), but causes more nausea and vomiting (RR 2.1 CI 1.2-3.8). The injected form of the drug causes more pain at the injection site than haloperidol (RR 5.3 CI 1.3-22).

Authors' conclusions

Currently data are limited. Ziprasidone may be an effective antipsychotic with less extrapyramidal effects than haloperidol. It also, however, causes more nausea and vomiting than the typical drugs, and, at present, there is no data suggesting that it is different to other atypical compounds. Well planned, conducted and reported long term randomised trials are needed if ziprasidone is to be accepted into everyday use.

 

Plain language summary

Ziprasidone for schizophrenia and severe mental illness

Pending

 

摘要

背景

ziprasidone使用在精神分裂症和嚴重精神疾病患者

典型的抗精神病劑是廣泛用來治療精神分裂症的第一線藥物。然而，非典型的抗精神病劑在這一方面正取得重要的進展。非典型是廣泛用來形容有些較不會產生運動障礙和增加血清泌乳激素的抗精神病劑。有些建議指出非典型抗精神病劑這些副作用的差異使得它更能為精神分裂症患者所接受。ziprasidone是一種較新的非典型藥物，對血清張力素受體有高的親和力。

目標

為了比較ziprasidone和安慰劑、典型以及其他非典型抗精神病劑在精神分裂症和相關精神疾病上的療效。

搜尋策略

電子資料庫搜尋了Biological Abstracts (1980 – 1999), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982 – 1999), EMBASE (1980 – 1999), MEDLINE (1966 – 1999), LILACS (1982 – 1996), PSYNDEX (1977 – 1999) and PsycLIT (1974 – 1999) 。另外，在Dialog Corporation Datastar and Dialog services 的藥理學資 料庫也被搜尋。所有選出文獻的參考資料也為了更多的試驗做搜尋。藥廠(Pfizer，ziprasidone以及所有比較性藥物的製造商)和所有納入試驗的第一作者都被聯繫。

選擇標準

比較ziprasidone和其他治療方式在精神分裂症或類似分裂症精神疾病的所有試驗都經由獨立的評估而被納入。

資料收集與分析

引證和摘要都儘可能獨立地被檢閱者所檢視、排序、再檢視且評估品質。資料都被獨立地摘錄。如果失去追蹤率超過50%則資料會被排除。同質性、歧異性的資料，其risk ratio, 95% confidence interval (CI) 和　the number needed to treat (NNT) 都在 intentiontotreat的基礎上做計算。連續性的資料，加權的平均差異(WMD)都被納入計算。所以資料都被檢視異質性。

主要結論

這個藥物的資料從非常短(一星期)的肌肉注射研究，到為期超過六個月的試驗都有。在心智狀態的測量，ziprasidone似乎比安慰劑有效(RR 0.8 CI 0.7 – 0.9)，並且和haloperidol同樣有效(RR 0.8 CI 0.7 – 1)。它比haloperidol較不會導致運動障礙(RR 0.4 CI 0.2 – 0.6)，但是導致較多的噁心、嘔吐(RR 2.1 CI 1.2 – 3.8)。注射型式的藥物比haloperidol導致注射部位較多的疼痛(RR 5.3 CI 1.3 – 22)。

作者結論

目前的資料還是有限。Ziprasidone也許是一個有效的抗精神病劑，而且比haloperidol有較少的椎體外徑副作用。然而，它比典型藥物導致較多的噁心、嘔吐。目前為止，並沒有證據顯示它和其他非典型藥物有不同。如果ziprasidone 要被接受成為每天使用的藥物，妥善計劃、被執行和報導的長期隨機試驗是需要的。

翻譯人

本摘要由彰化基督教醫院謝明翰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

概要正等待中。