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. 2018 Feb 6;2018(2):CD000459. doi: 10.1002/14651858.CD000459.pub3

Comparison 3. Switch to a specific antipsychotic vs switch to a different antipsychotic.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Tardive dyskinesia: no clinically important improvement 4   Risk Ratio (IV, Fixed, 95% CI) Subtotals only
1.1 Thiopropazate vs haloperidol ‐ short term 1 20 Risk Ratio (IV, Fixed, 95% CI) 1.53 [0.58, 4.05]
1.2 Zuclopenthixol vs haloperidol ‐ short term 1 15 Risk Ratio (IV, Fixed, 95% CI) 1.0 [0.79, 1.27]
1.3 Olanzapine vs risperidone ‐ medium term 1 60 Risk Ratio (IV, Fixed, 95% CI) 1.25 [0.82, 1.90]
1.4 Quetiapine vs haloperidol ‐ medium term 1 45 Risk Ratio (IV, Fixed, 95% CI) 0.80 [0.52, 1.22]
1.5 Quetiapine vs haloperidol ‐ long term 1 45 Risk Ratio (IV, Fixed, 95% CI) 0.88 [0.64, 1.21]
2 Tardive dyskinesia: not any improvement (short term) 2   Risk Ratio (IV, Fixed, 95% CI) Subtotals only
2.1 Thiopropazate vs haloperidol 1 20 Risk Ratio (IV, Fixed, 95% CI) 0.41 [0.05, 3.28]
2.2 Zuclopenthixol vs haloperidol 1 15 Risk Ratio (IV, Fixed, 95% CI) 0.88 [0.16, 4.68]
3 Tardive dyskinesia: deterioration (short term) 2   Risk Ratio (IV, Fixed, 95% CI) Subtotals only
3.1 Thiopropazate vs haloperidol 1 20 Risk Ratio (IV, Fixed, 95% CI) 1.22 [0.09, 16.92]
3.2 Zuclopenthixol vs haloperidol 1 15 Risk Ratio (IV, Fixed, 95% CI) 0.88 [0.16, 4.68]
4 Tardive dyskinesia: average endpoint score (various scales) 3   Mean Difference (IV, Fixed, 95% CI) Subtotals only
4.1 Molindone vs haloperidol, 100% masking dose (AIMS, short term) 1 18 Mean Difference (IV, Fixed, 95% CI) 1.87 [‐0.20, 3.94]
4.2 Molindone vs haloperidol, 200% masking dose (AIMS, short term) 1 18 Mean Difference (IV, Fixed, 95% CI) 3.44 [1.12, 5.76]
4.3 Zuclopenthixol vs haloperidol (SHRS, short term) 1 15 Mean Difference (IV, Fixed, 95% CI) ‐4.81 [‐12.15, 2.53]
4.4 Olanzapine vs risperidone (AIMS, medium term) 1 60 Mean Difference (IV, Fixed, 95% CI) 2.20 [‐0.53, 4.93]
5 Tardive dyskinesia: average change score (AIMS, low = better) (medium term) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
5.1 Olanzapine vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) 1.66 [‐0.45, 3.77]
5.2 Amisulpride vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.82 [‐2.85, 1.21]
5.3 Olanzapine vs amisulpride 1 54 Mean Difference (IV, Fixed, 95% CI) 2.48 [0.44, 4.52]
5.4 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) 1.20 [‐2.58, 4.98]
6 General mental state: deterioration 3   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
6.1 Zuclopenthixol vs haloperidol ‐ short term 1 15 Risk Ratio (M‐H, Fixed, 95% CI) 0.30 [0.01, 6.29]
6.2 Olanzapine vs risperidone ‐ medium term 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 1.0 [0.15, 6.64]
6.3 Quetiapine vs haloperidol ‐ long term 1 45 Risk Ratio (M‐H, Fixed, 95% CI) 1.83 [0.62, 5.39]
7 General mental state: average endpoint score (PANSS‐general psychopathology, low = better) (long term) 1 45 Mean Difference (IV, Fixed, 95% CI) ‐2.20 [‐6.02, 1.62]
7.1 Quetiapine vs haloperidol 1 45 Mean Difference (IV, Fixed, 95% CI) ‐2.20 [‐6.02, 1.62]
8 General mental state: average change score (BPRS, low = better) (medium term) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
8.1 Olanzapine vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐1.14 [‐4.79, 2.51]
8.2 Amisulpride vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐2.46 [‐6.27, 1.35]
8.3 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) ‐1.70 [‐8.37, 4.97]
8.4 Olanzapine vs amisulpride 1 54 Mean Difference (IV, Fixed, 95% CI) 1.32 [‐1.94, 4.58]
9 Acceptability of the treatment: leaving the study early (short term) 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
9.1 Molindone vs haloperidol 1 18 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
9.2 Thiopropazate vs haloperidol 1 20 Risk Ratio (M‐H, Fixed, 95% CI) 0.24 [0.01, 4.44]
10 Acceptability of the treatment: leaving the study early (medium term) 3   Risk Ratio (IV, Fixed, 95% CI) Subtotals only
10.1 Olanzapine vs FGA 1 56 Risk Ratio (IV, Fixed, 95% CI) 1.86 [0.18, 19.38]
10.2 Amisulpride vs FGA 1 55 Risk Ratio (IV, Fixed, 95% CI) 0.96 [0.06, 14.65]
10.3 Olanzapine vs amisulpride 1 57 Risk Ratio (IV, Fixed, 95% CI) 1.93 [0.19, 20.12]
10.4 Olanzapine vs risperidone 2 170 Risk Ratio (IV, Fixed, 95% CI) 0.73 [0.57, 0.95]
10.5 Olanzapine vs quetiapine 1 116 Risk Ratio (IV, Fixed, 95% CI) 0.70 [0.54, 0.90]
10.6 Olanzapine vs ziprasidone 1 82 Risk Ratio (IV, Fixed, 95% CI) 0.77 [0.56, 1.05]
10.7 Quetiapine vs risperidone 1 118 Risk Ratio (IV, Fixed, 95% CI) 1.05 [0.88, 1.25]
10.8 Quetiapine vs ziprasidone 1 90 Risk Ratio (IV, Fixed, 95% CI) 1.10 [0.86, 1.40]
10.9 Ziprasidone vs risperidone 1 84 Risk Ratio (IV, Fixed, 95% CI) 0.95 [0.74, 1.23]
11 Acceptability of the treatment: leaving the study early (long term) 2   Risk Ratio (IV, Fixed, 95% CI) Subtotals only
11.1 Clozapine vs haloperidol 1 39 Risk Ratio (IV, Fixed, 95% CI) 3.36 [0.45, 25.16]
11.2 Quetiapine vs haloperidol 1 45 Risk Ratio (IV, Fixed, 95% CI) 1.31 [0.63, 2.69]
12 Adverse events: extrapyramidal symptoms (need of antiparkinsonism drugs) 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
12.1 Risperidone vs haloperidol (medium term) 1 37 Risk Ratio (M‐H, Fixed, 95% CI) 0.68 [0.34, 1.35]
12.2 Quetiapine vs haloperidol (long term) 1 45 Risk Ratio (M‐H, Fixed, 95% CI) 0.45 [0.21, 0.96]
13 Adverse effects: parkinsonism (SHRS) ‐ average endpoint scores (short term) 1 15 Mean Difference (IV, Fixed, 95% CI) ‐4.81 [‐12.15, 2.53]
13.1 Zuclopenthixol vs haloperidol 1 15 Mean Difference (IV, Fixed, 95% CI) ‐4.81 [‐12.15, 2.53]
14 Adverse effects: parkinsonism (SAS, ESRS, low = better) ‐ average change score (medium term) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
14.1 Olanzapine vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.85 [‐2.55, 0.85]
14.2 Amisulpride vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.5 [‐2.45, 1.45]
14.3 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) ‐0.7 [‐1.33, ‐0.07]
14.4 Olanzapine vs amisulpride 1 54 Mean Difference (IV, Fixed, 95% CI) ‐0.35 [‐2.44, 1.74]
15 Adverse effects: dyskinesia (ESRS, low = better) ‐ average change score (medium term) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
15.1 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) 0.30 [‐0.91, 1.51]
16 Adverse effects: akathisia (BAS, ESRS, low = better) ‐ average change scores (medium term) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
16.1 Olanzapine vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) 0.08 [‐0.30, 0.46]
16.2 Amisulpride vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.11 [‐0.42, 0.20]
16.3 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) ‐0.8 [‐1.76, 0.16]
16.4 Olanzapine vs amisulpride 1 54 Mean Difference (IV, Fixed, 95% CI) 0.19 [‐0.12, 0.50]
17 Adverse effects: dystonia (ESRS, low = better) ‐ average change score (medium term) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
17.1 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) ‐0.7 [‐1.41, 0.01]
18 Adverse effects: general adverse events (UKU, low = better) ‐ average change score (medium term) 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
18.1 Olanzapine vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) 0.08 [‐1.85, 2.01]
18.2 Amisulpride vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.55 [‐2.33, 1.23]
18.3 Olanzapine vs amisulpride 1 54 Mean Difference (IV, Fixed, 95% CI) 0.63 [‐0.93, 2.19]
19 General global state: average change score (CGI) (medium term) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
19.1 Olanzapine vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.07 [‐0.41, 0.27]
19.2 Amisulpride vs FGA 1 53 Mean Difference (IV, Fixed, 95% CI) ‐0.19 [‐0.47, 0.09]
19.3 Olanzapine vs risperidone 1 60 Mean Difference (IV, Fixed, 95% CI) 0.10 [‐0.61, 0.81]
19.4 Olanzapine vs amisulpride 1 54 Mean Difference (IV, Fixed, 95% CI) 0.12 [‐0.19, 0.43]