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Annotation

Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, Davis JM. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet . 2012 Jun 2 ; 379(9831):2063-71. PubMed Abstract

Comments on Paper and Primary News
Primary News: Meta-Analysis Finds Antipsychotics Help Prevent Relapse in Schizophrenia

Comment by:  William Carpenter, SRF Advisor (Disclosure)
Submitted 23 May 2012 Posted 23 May 2012

Since the John Davis meta-analysis in the 1970s (the second meta-analysis in medicine; see Davis, 1975), there is little doubt that drug beats placebo in relapse prevention. What is terrific here are the details on aspects of course that are addressed and more information on the risk side to complement benefit. I will comment on two findings. First, depot beats oral. Especially in the United States, we need to move depot into an attractive option and first-line approach (assuming oral administration of the same compound supports safety in the individual). Second, I have thought that there is little evidence for second-generation antipsychotics being superior to first-generation antipsychotics (clozapine excepted) in efficacy and effectiveness, and that the strongest case for second-generation antipsychotics was better relapse prevention. This meta-analysis failed to support this supposed advantage, and I have to adjust my view in this regard.

The van Os and Howes commentary merits a serious and thoughtful read. It gives...  Read more


View all comments by William Carpenter

Primary News: Meta-Analysis Finds Antipsychotics Help Prevent Relapse in Schizophrenia

Comment by:  Wolfgang Gaebel
Submitted 21 June 2012 Posted 22 June 2012
  I recommend this paper

Antipsychotics are (generally) effective in relapse prevention—however, evidence-based indicators for more individualized treatment are needed.

Leucht and colleagues (Leucht et al., 2012) conducted a new, highly comprehensive, but also very differentiated meta-analysis on the relapse preventive efficacy of antipsychotic drugs as compared to placebo, which is now published in The Lancet. In addition, detailed comments are provided by van Os and Howes (van Os and Howes, 2012) in the same issue. As in former reviews addressing this topic, the results clearly underline that antipsychotics are (generally) effective in preventing relapse in schizophrenia compared to placebo with average one-year relapse rates of 27 percent versus 64 percent, an estimated risk ratio of 0.4, and a number of 3 needed to treat (to benefit) patients. On the other hand, and despite this high-grade evidence, many patients with schizophrenia still show cognitive, affective, motivational, or "functional"...  Read more


View all comments by Wolfgang Gaebel
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