Summary of findings for the main comparison. Antipsychotic dose increase compared to antipsychotic dose continuation for non response in schizophrenia.
| Antipsychotic dose increase compared to antipsychotic dose continuation for non response in schizophrenia | ||||||
| Patient or population: non response in schizophrenia Setting: inpatients and outpatients Intervention: antipsychotic dose increase Comparison: antipsychotic dose continuation | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with antipsychotic dose continuation | Risk with antipsychotic dose increase | |||||
| Global state: clinically relevant response: Assessed with response ratio follow‐up: range 2 weeks to 12 weeks | Study population | RR 1.09 (0.86 to 1.40) | 533 (9 RCTs) | ⊕⊕⊝⊝ LOW 1 | ||
| 309 per 1000 | 336 per 1000 (265 to 432) | |||||
| Leaving the study early: tolerability ‐ leaving early due to adverse effects. Assessed with risk ratio follow‐up: range 2 weeks to 9 weeks | Study population | RR 1.63 (0.52 to 5.07) | 496 (7 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | ||
| 74 per 1000 | 121 per 1000 (39 to 376) | |||||
| Leaving the study early: acceptability ‐ leaving early due to any reason. Assessed with: Risk ratio follow‐up: range 2 weeks to 9 weeks | Study population | RR 1.30 (0.89 to 1.90) | 353 (5 RCTs) | ⊕⊕⊝⊝ LOW 1 | ||
| 23 per 100 | 30 per 100 (20 to 43) | |||||
| General mental state : PANSS total score change* assessed with: Weighted mean difference follow‐up: range 2 weeks to 9 weeks | The mean general mental state ‐ PANSS total score change ranged from −8.9 to 0.03 points | MD 1.44 points lower (6.85 lower to 3.97 higher) | ‐ | 258 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 3 4 5 | One other trial used the BPRS total score change and showed no clear difference between the two groups. Pre‐defined outcome: Clinically important change in general mental state not reported. |
| Adverse effects ‐ at least one adverse effect assessed with: Risk ratio follow‐up: range 2 weeks to 9 weeks | Study population | RR 0.91 (0.55 to 1.50) | 191 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 6 | ||
| 716 per 1000 | 652 per 1000 (394 to 1000) | |||||
| Service use: time in hospital | ‐ | see comment | ‐ | (0 studies) | ‐ | No studies reported this outcome. |
| Quality of life ‐ clinically important change in quality of life (defined as at least 50% improvement in HQLS) | Study population | not estimable | 17 (1 RCT) | ⊕⊕⊝⊝ LOW 1 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| *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 certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Imprecision for dichotomous outcomes: a) sample size should be >800 and/or total number of events>300; in our review, both numbers are much smaller. b) the pooled estimate of effect includes both no effect and an appreciable benefit or appreciable harm.
2 Inconsistency: Heterogeneity: Tau² = 1.03; Chi² = 11.24, df = 5 (P = 0.05); I² = 56%
3 Inconsistency: Heterogeneity: Tau² = 14.71; Chi² = 5.70, df = 2 (P = 0.06); I² = 65%
4 Imprecision for continuous outcomes: a) sample size is lower than 400, b) confidence interval includes no effect and the upper or lower confidence limit crosses the minimal important difference (MID), either for benefit of harm
5 Indirectness: The pre‐specified outcome (clinical important change in mental state) was not reported.
6 Inconsistency: Heterogeneity: Tau² = 0.10; Chi² = 3.62, df = 1 (P = 0.06); I² = 72%