Summary of findings for the main comparison. Reduced dose of antipsychotics compared with antipsychotic maintenance for antipsychotic‐induced tardive dyskinesia.
| Reduced dose of antipsychotic compared with antipsychotic maintenance for antipsychotic‐induced tardive dyskinesia | ||||||
| Patient or population: psychiatric patients (schizophrenia or schizoaffective disorder) with antipsychotic‐induced tardive dyskinesia Setting: inpatients and outpatients in the UK (1 study) and the USA (1 study) Intervention: Reduced dose of antipsychotic Comparison: Antipsychotic maintenance | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with antipsychotic maintenance | Risk with reduced dose of antipsychotic | |||||
| Tardive dyskinesia: no clinically important improvement Follow‐up: 44‐48 weeks | Study population | RR 0.42 (0.17 to 1.04) | 17 (2 RCTs) | ⊕⊝⊝⊝ Very low1,2 | ||
| 875 per 1000 | 368 per 1000 (149 to 910) | |||||
| Tardive dyskinesia: deterioration of symptoms Follow‐up: 44‐48 weeks | Study population | RR 0.61 (0.11 to 3.31) | 17 (2 RCTs) | ⊕⊝⊝⊝ Very low1,2 | ||
| 250 per 1000 | 153 per 1000 (28 to 828) | |||||
| General mental state: relapse Follow‐up: 44‐48 weeks | Study population | RR 3.00 (0.16 to 57.36) | 8 (1 RCT) | ⊕⊝⊝⊝ Very low2,3 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Adverse effect: any ‐ not reported | See comment | See comment | Not estimable | (0 studies) | ‐ | None of the included studies reported on this outcome. |
| Adverse effect: extrapyramidal symptoms ‐ not reported | See comment | See comment | Not estimable | (0 studies) | ‐ | None of the included studies reported on this outcome. |
| Acceptability of the treatment: leaving the study early Follow‐up: 44‐48 weeks | Study population | RR 0.33 (0.06 to 1.99) | 8 (1 RCT) | ⊕⊝⊝⊝ Very low2,3,4 | ||
| 750 per 1000 | 248 per 1000 (45 to 1000) | |||||
| Social confidence, social inclusion, social networks, or personalised quality of life ‐ not reported | See comment | See comment | Not estimable | (0 studies) | ‐ | None of the included studies reported on this outcome. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
1Downgraded one level for risk of bias: none of the studies adequately described allocation concealment, one study was a subsample from one site of an RCT, and one study's baseline characteristics were not balanced between study groups. 2Downgraded two levels for imprecision: 95% CI includes both no effect and appreciable benefit for antipsychotic reduced dose; very small sample size. 3Downgraded one level for risk of bias: allocation concealment was not adequately described, only a subsample from one site of an RCT qualified for inclusion. 4Downgraded one level for indirectness: leaving the study early can give an indication, but is not a direct measurement, of treatment acceptability.