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Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

  • Nicolas A. Crossley (a1), Miguel Constante (a1), Philip McGuire (a2) and Paddy Power (a3)

Abstract

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.

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Copyright

Corresponding author

Nicolas A. Crossley, Division of Psychological Medicine, Institute of Psychiatry PO 67, De Crespigny Park, London SE5 8AF. Email: nicolas.crossley@kcl.ac.uk

Footnotes

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N.A.C. is in receipt of an Academic Training Fellowship from the National Institute of Health Research, UK.

Declaration of interest

None.

Footnotes

References

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Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

  • Nicolas A. Crossley (a1), Miguel Constante (a1), Philip McGuire (a2) and Paddy Power (a3)
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