Summary of findings 6. Lithium compared to olanzapine for acute mania.
| Lithium compared to olanzapine for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients Intervention: lithium Comparison: olanzapine | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with olanzapine | Risk with lithium | |||||
|
Efficacy: response (categorical) MSRS/YMRS ≥ 50% decrease in score by end of study |
Study population | OR 0.44 (0.20 to 0.94) | 180 (2 RCTs) | ⊕⊕⊕⊝ Moderate1 | ||
| 730 per 1000 | 544 per 1000 (351 to 718) | |||||
|
Efficacy: response (continuous) CGI severity score at end of study |
The mean efficacy: response (continuous) CGI severity endpoint score in the olanzapine group ranged between 2.26 and 3.69 | The mean efficacy: response (continuous) CGI severity endpoint score in the lithium group ranged between 2.83 and 3.41 | ‐ | 210 (3 RCTs) | ⊕⊕⊝⊝ Low2 | |
|
Efficacy: remission (categorical) YMRS ≤ 12 at end of study |
Study population | OR 2.00 (0.89 to 4.46) | 140 (1 RCT) | ⊕⊕⊝⊝ Low3 | ||
| 826 per 1000 | 905 per 1000 (809 to 955) | |||||
| Acceptability: total withdrawals | Study population | OR 2.60 (1.13 to 5.99) | 210 (3 RCTs) | ⊕⊕⊝⊝ Low4 | ||
| 87 per 1000 | 198 per 1000 (97 to 362) | |||||
| 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). CGI: Clinical Global Impression; CI: confidence interval; MSRS: Manic‐State Rating Scale; 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 publication bias. Olanzapine is used widely to treat acute mania; why so few studies? The lack of studies precluded the use of funnel plots. 2Berk 1999 rated as high risk of bias for selective reporting. Downgraded one level for risk of bias. Downgraded one level for suspected publication bias as described above. 3Downgraded one level for imprecision. Wide confidence interval on single small study. Downgraded one level for suspected publication bias as described above. 4All studies have wide confidence intervals; strongly suspect result to be an overestimate of favouring olanzapine. Downgraded one level for imprecision. Downgraded one level for suspected publication bias as described above.