Summary of findings 5. Lithium compared to quetiapine for acute mania.
| Lithium compared to quetiapine for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients Intervention: lithium Comparison: quetiapine | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with quetiapine | Risk with lithium | |||||
|
Efficacy: response (categorical) YMRS decrease by ≥ 50% by end of study |
Study population | OR 0.66 (0.28 to 1.55) | 335 (2 RCTs) | ⊕⊝⊝⊝ Very low1,2,3 | ||
| 644 per 1000 | 544 per 1000 (336 to 737) | |||||
|
Efficacy: response (continuous) YMRS change from baseline to end of study |
The mean efficacy: response (continuous) YMRS change from baseline to end of study in the quetiapine group ranged from −20.28 to −18.2 | The mean efficacy: response (continuous) YMRS change from baseline to end of study in the lithium group ranged from −20.76 to −15.9 | ‐ | 359 (2 RCTs) | ⊕⊕⊝⊝ Low1,3 | |
|
Efficacy: remission (categorical) Decrease in YMRS ≤ 12 by end of study |
Study population | OR 0.64 (0.26 to 1.57) | 359 (2 RCTs) | ⊕⊕⊝⊝ Low1,3 | ||
| 538 per 1000 | 427 per 1000 (232 to 646) | |||||
| Acceptability: total withdrawals | Study population | OR 1.38 (0.83 to 2.28) | 359 (2 RCTs) | ⊕⊝⊝⊝ Very low1,3,4 | ||
| 212 per 1000 | 271 per 1000 (182 to 380) | |||||
| Adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | No study measured 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; OR: odds ratio; RCT: randomised controlled trial; YMRS: Young Mania Rating Scale | ||||||
| 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. | ||||||
1Downgraded one level for inconsistency. High heterogeneity from two similar studies. 2Downgraded one level for imprecision: wide confidence intervals. 3Outcome 1 downgraded for publication bias. Only two studies found for this outcome, which makes it likely that there are unpublished data not found by our search. 4Downgraded one level for imprecision. Large study with tight confidence interval, small study with wide confidence interval. This is to be expected, but it means the precision is highly dependent upon one study.