Summary of findings 2. RISPERIDONE versus OLANZAPINE ‒ short‐ and long‐term data for people with severe mental illness and co‐occurring substance misuse.
| RISPERIDONE versus OLANZAPINE‐ all data short term (up to 6 months) for people with severe mental illness and co‐occurring substance misuse | ||||||
| Patient or population: people with serious mental illness and co‐occurring substance misuse Setting: In and outpatients, United States Intervention: Risperidone Comparison: Olanzapine | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with Olanzapine | Risk with Risperidone | |||||
| Mental state: 2. Specific‐ Positive symptoms, total score‐ average endpoint scores (SADS‐C‐PD scale, lower = better) | The mean positive symptoms total score at endpoint (SADS‐C‐PD scale, lower = better) in the intervention group was 1.5 lower (3.82 lower to 0.82 higher) | ‐ | 37 (1 RCT) | ⊕⊝⊝⊝ very low1 2 | ||
| Substance use: 1. Reduction of cannabis use‐change data (number of joints smoked/week) | The reduction of cannabis joints smoked (number of joints smoked/week‐short term data, up to 6 months) in the intervention group was 0.4 higher (4.72 lower to 5.52 higher) | ‐ | 41 (1 RCT) | ⊕⊝⊝⊝ very low3 4 | ||
| Subjective well‐being | ‐ | ‐ | ‐ | No trial reported on this important outcome for participants with a co‐occurring substance use disorder | ||
| Craving for substances: 2. Drug Desires Questionnaire‐ average endpoint scores (DDQ, lower = better) | The mean endpoint. Drug Desires Questionnaire‐ endpoint scores (DDQ, lower = better), short term, up to 6 months‐in the intervention group was5 higher (4.86 lower to 14.86 higher) | ‐ | 41 (1 RCT) | ⊕⊝⊝⊝ very low2 3 | ||
| Adherence to antipsychotic medication: number of missed doses, average endpoint data, short term (up to 6 months) | ‐ | ‐ | ‐ | ‐ | no useable data available for this outcome | |
| Adverse effects: Parkinsonism ‐ average endpoint score (SAS, high = worse) | The mean adverse effects: ‐ Parkinsonism‐ average endpoint score (SAS, high = worse)‐ short‐term‐ up to 6 months in the intervention group was 0.08 lower (1.21 lower to 1.05 higher) | ‐ | 16 (1 RCT) | ⊕⊝⊝⊝ very low2 5 | ||
| Leaving study early: any reason | Study population | RR 0.68 (0.34 to 1.35) | 77 (2 RCTs) | ⊕⊝⊝⊝ very low4 6 | ||
| 357 per 1000 | 243 per 1000 (121 to 482) | |||||
| Moderate | ||||||
| 411 per 1000 | 279 per 1000 (140 to 554) | |||||
| *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; RR: Risk ratio; OR: Odds 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 | ||||||
1 High risk for performance bias, allocation concealment, unknown risk for attrition and slective reporting
2 Very low sample size, optimal information size (OIS) not met
3 High risk of attrition bias, study sponsored by pharmaceutical industry
4 Very low sample size, optimal information criterion not met, CI crosses both appreciable harm and benefit
5 High attrition risk, high other risk of funding by pharmaceutical industry, all other risk items unclear risk of bias
6 High risk of performance, attrition and funding bias. Several domains with unclear risk of bias