Amisulpride versus other atypical antipsychotics for schizophrenia

 

Abstract

Background

In many countries of the industrialised world second generation (atypical) antipsychotics have become first line drug treatments for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examine how the efficacy and tolerability of amisulpride differs from that of other second generation antipsychotics.

Objectives

To evaluate the effects of amisulpride compared with other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychoses.

Search methods

We searched the Cochrane Schizophrenia Group Trials Register (April 2007) which is based on regular searches of BIOSIS, CINAHL, EMBASE, MEDLINE and PsycINFO.

Selection criteria

We included randomised, at least single-blind, trials comparing oral amisulpride with oral forms of aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychoses.

Data collection and analysis

We extracted data independently. For continuous data we calculated weighted mean differences (MD), for dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate.

Main results

The review currently includes ten short to medium term trials with 1549 participants on three comparisons: amisulpride versus olanzapine, risperidone and ziprasidone. The overall attrition rate was considerable (34.7%) with no significant difference between groups. Amisulpride was similarly effective as olanzapine and risperidone and more effective than ziprasidone (leaving the study early due to inefficacy: n=123, 1 RCT, RR 0.21 CI 0.05 to 0.94, NNT 8 CI 5 to 50). Amisulpride induced less weight gain than risperidone (n=585, 3 RCTs, MD -0.99 CI -1.61 to -0.37) or olanzapine (n=671, 3 RCTs, MD -2.11 CI -2.94 to -1.29). Olanzapine was also associated with a higher increase of glucose (n=406, 2 RCTs, MD -7.30 CI -7.62 to -6.99). There was no difference in terms of cardiac effects and extra pyramidal symptoms (EPS) compared with olanzapine (akathisia: n= 587, 2 RCTs, RR 0.66 CI 0.36 to 1.21), compared with risperidone (akathisia: n=586, 3 RCTs, RR 0.80 CI 0.58 to 1.11) and compared with ziprasidone (akathisia: n=123, 1 RCT, RR 0.63, CI 0.11 to 3.67).

Authors' conclusions

There is little randomised evidence comparing amisulpride with other second generation antipsychotic drugs. We could only find trials comparing amisulpride with olanzapine, risperidone and ziprasidone. We found amisulpride may be somewhat more effective than ziprasidone, and more tolerable in terms of weight gain and other associated problems than olanzapine and risperidone. These data, however, are based on only ten short to medium term studies and therefore too limited to allow for firm conclusions.

 

Plain language summary

Amisulpride versus other atypical antipsychotics for schizophrenia

This review compared the effects of amisulpride with those of other so called second generation (atypical) antipsychotic drugs. For half of the possible comparisons not a single relevant study could be identified. Based on very limited data there was no difference in efficacy comparing amisulpride with olanzapine and risperidone, but a certain advantage compared with ziprasidone. Amisulpride was associated with less weight gain than risperidone and olanzapine.

 

摘要

背景

Amisulpride和其他非典型抗精神病藥物在精神分裂症應用上的比較

許多工業化世界的國家中,第二代(非典型)抗精神病藥物已經成為精神病患的第一線用藥. 對不同的第二代抗精神病藥物效果是否有差異,且若有差異下此差異的程度是個值得討論得議題. 在此文獻回顧中我們將檢視Amisulpride和其他第二代抗精神病藥物在療效與可接受性有如何的差異.

目標

評估amisulpride對比其他非典型抗精神病藥物在治療精神分裂症或類精神分裂症精神病之療效.

搜尋策略

我們搜尋來自於規則搜尋BIOSIS、CINAHL、EMBASE、MEDLINE和PsycINFO等資料庫的Cochrane Schizophrenia Group Trials Register(2007年4月)。

選擇標準

我們納入比較口服amisulpride及其他口服劑型之aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone 或zotepine在治 療精神分裂症或類精神分裂症精神病之隨機分配或至少是單盲的臨床試驗.

資料收集與分析

我們獨立擷取資料，根據隨機分配效應模組，以意向治療為基礎，我們對連續性資料計算了weighted mean differences(MD)，對二分法資料計算relative risks(RR)及95% confidence intervals(CI)。我們也適當地計算numbers needed to treat/harm (NNT/NNH)。

主要結論

此文獻回顧目前納入10篇短至中型臨床試驗,1549受試者針對3個組合比較amisulpride對比olanzapine, risperidone對比ziprasidone.整體耗損率較大(34.7%),但各組沒有統計差異. Amisulpride和olanzapine與risperidone一樣有效,但比ziprasidone具有療效.(因療效不佳的早期退出率: n = 123, 1 RCT, RR 0.21 CI 0.05 to 0.94, NNT 8 CI 5 to 50). Amisulpride 對比risperidone (n = 585, 3 RCTs, MD −0.99 CI −1.61 to −0.37) 和olanzapine(n = 671, 3 RCTs, MD −2.11 CI −2.94 to −1.29) 較少出現體重增加. olanzapine也和血糖上升較高有關(n = 406, 2 RCTs, MD −7.30 CI −7.62 to −6.99). 在對比其他3種抗精神病要時,對心臟效果,錐體外症候群(EPS)沒有差異. 對比olanzapine(靜坐不能: n = 587, 2 RCTs, RR 0.66 CI 0.36 to 1.21), 對比risperidone(靜坐不能: n = 586, 3 RCTs, RR 0.80 CI 0.58 to 1.11),對比ziprasidone (靜坐不能: n = 123, 1 RCT, RR 0.63, CI 0.11 to 3.67).

作者結論

amisulpride比較其他第二代抗精神病藥物的隨機分配實證還是少數. 我們僅能搜尋到amisulpride對比olanzapine, risperidone和ziprasidone的臨床試驗. 我們發現amisulpride可能比ziprasidone稍為有效且在體重增加或其他olanzapine和risperidone相關的問題更可被接受. 然而,這些資料僅根據10篇短至中型臨床試驗,因此太侷限證據去確立結論.

翻譯人

本摘要由彰化基督教醫院張庭綱翻譯。

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

總結

Amisulpride和其他非典型抗精神病藥物在精神分裂症應用上的對比:此文獻回顧比較amisulpride和所謂的第二代(非典型)抗精神病藥物的藥效. 半數的可能對比組合並非單一相關研究而不能被納入. 根據非常侷限的的資料, amisulpride 對比olanzapine和risperidone在療效上並無差異,但對比ziprasidone有一定之優勢. Amisulpride對比risperidone和olanzapine較不會造成體重增加.