RESEARCH REPORT
Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis Britta Galling1-3, Alexandra Roldan4, Katsuhiko Hagi2,5, Liz Rietschel6, Frozan Walyzada2, Wei Zheng7, Xiao-Lan Cao8, Yu-Tao Xiang9, Mathias Zink10, John M. Kane2,3,11,12, Jimmi Nielsen13,14, Stefan Leucht15, Christoph U. Correll2,3,11,12 1
Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charite-Universit€atsmedizin Berlin, Berlin, Germany; 2Zucker Hillside Hospital, o Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; 3Hofstra Northwell School of Medicine, Hempstead, NY, USA; 4Department of Psychiatry, Institut d’Investigaci Biome`dica Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Aut onoma de Barcelona, Barcelona, Spain; 5Sumitomo Dainippon Pharma Co., Tokyo, Japan; 6University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; 7Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; 8Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China; 9Unit of Psychiatry, Faculty of Health Sciences, University of Macao, Taipa, Macao, SAR, China; 10Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 11Feinstein Institute for Medical Research, Manhasset, NY, USA; 12Albert Einstein College of Medicine, Bronx, NY, USA; 13Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark; 14 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 15Klinik und Poliklinik f€ur Psychiatrie und Psychotherapie, Technische Universit€at M€unchen, Munich, Germany
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N5694, standardized mean difference, SMD5–0.53, 95% CI: 20.87 to 20.19, p50.002). However, superiority was only apparent in open-label and low-quality trials (both p
Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis Britta Galling1-3, Alexandra Roldan4, Katsuhiko Hagi2,5, Liz Rietschel6, Frozan Walyzada2, Wei Zheng7, Xiao-Lan Cao8, Yu-Tao Xiang9, Mathias Zink10, John M. Kane2,3,11,12, Jimmi Nielsen13,14, Stefan Leucht15, Christoph U. Correll2,3,11,12 1
Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charite-Universit€atsmedizin Berlin, Berlin, Germany; 2Zucker Hillside Hospital, o Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; 3Hofstra Northwell School of Medicine, Hempstead, NY, USA; 4Department of Psychiatry, Institut d’Investigaci Biome`dica Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Aut onoma de Barcelona, Barcelona, Spain; 5Sumitomo Dainippon Pharma Co., Tokyo, Japan; 6University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; 7Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; 8Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China; 9Unit of Psychiatry, Faculty of Health Sciences, University of Macao, Taipa, Macao, SAR, China; 10Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 11Feinstein Institute for Medical Research, Manhasset, NY, USA; 12Albert Einstein College of Medicine, Bronx, NY, USA; 13Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark; 14 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 15Klinik und Poliklinik f€ur Psychiatrie und Psychotherapie, Technische Universit€at M€unchen, Munich, Germany
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N5694, standardized mean difference, SMD5–0.53, 95% CI: 20.87 to 20.19, p50.002). However, superiority was only apparent in open-label and low-quality trials (both p
