Summary of findings 2. PERPHENAZINE compared with ANY ANTIPSYCHOTICS for schizophrenia.
| PERPHENAZINE compared with ANY ANTIPSYCHOTICS for schizophrenia | ||||||
| Patient or population: patients with schizophrenia Settings: multi‐centre and single‐centre; international Intervention: PERPHENAZINE Comparison: ANY ANTIPSYCHOTICS | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| ANY ANTIPSYCHOTICS | PERPHENAZINE | |||||
| Global state: Change over time ‐ no better or deterioration ‐ short and medium term as defined in each study Follow‐up: mean 8 weeks | Low1 | RR 1.04 (0.91 to 1.17) | 1879 (17 studies) | ⊕⊝⊝⊝ very low2,3,4 | ||
| 50 per 1000 | 52 per 1000 (46 to 58) | |||||
| Moderate1 | ||||||
| 450 per 1000 | 468 per 1000 (410 to 526) | |||||
| High1 | ||||||
| 900 per 1000 | 936 per 1000 (819 to 1000) | |||||
| Mental state: State ‐ 'no effect' BPRS score reduction Follow‐up: mean 8 weeks | 216 per 10005 | 267 per 1000 (132 to 543) | RR 1.24 (0.61 to 2.52) | 383 (4 studies) | ⊕⊝⊝⊝ very low4,6,7,8 | |
| Death ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | No study reported this outcome |
| Adverse events: extrapyramidal adverse effects dystonia ‐ short term Follow‐up: mean 10 weeks | 33 per 10005 | 59 per 1000 (21 to 166) | RR 1.36 (0.23 to 8.16) | 416 (4 studies) | ⊕⊝⊝⊝ very low4,8,9,10 | |
| Other adverse events: any serious adverse event ‐ short and long term Follow‐up: mean 39 weeks | Study population | RR 0.98 (0.68 to 1.41) | 1760 (2 studies) | ⊕⊝⊝⊝ very low4,12,13 | ||
| 109 per 100011 | 108 per 1000 (81 to 147) | |||||
| Moderate | ||||||
| 152 per 100011 | 150 per 1000 (112 to 204) | |||||
| Economic outcomes ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | No study reported this outcome |
| Service use and hospitalisation: admission ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | No study reported this outcome |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Control risk: three risks presented based on control risk in included studies; 'moderate' equates with total control group risk (47.8%) 2 Risk of bias: rated 'serious' ‐ only four studies of seventeen adequately reported randomisation methods; most studies rated 'high' on at least one risk of bias domain, including detected selective reporting and attrition bias 3 Indirectness: rated 'serious' ‐ each included study involved different antipsychotic drugs as comparators (sulpiride, clopenthixol, benperidol, loxapine, risperidone, zotepine, clothiapine, thiothixene, methyperidol, penfluridol, aripiprazole, clocapramine, prochlorperazine, trifluopromazine, mepazine, promethazine, zuclopenthixol, timiperone) 4 Imprecision: rated 'serious' ‐ 95% confidence intervals for best estimate of effect include both 'no effect' and appreciable benefit/harm. 5 Control risk: mean baseline risk presented; considerable heterogeneity in results to be wary of 6 Risk of bias: rated 'serious' ‐ no studies adequately explained randomisation; two studies rated as 'high' on at least one risk of bias domain, including attrition bias and detected selective reporting 7 Inconsistency: rated 'serious' ‐ heterogeneity was considerable (Chi² = 5.25, df=3 (P = 0.15); I² = 43%). Suspected heterogeneity due to different comparator drugs used in all four studies (quetiapine; risperidone; aripiprazole; clozapine and clozapine + perphenazine) 8 Indirectness: rated 'serious' ‐ each included study involved different antipsychotic drugs as comparators 9 Risk of bias: rated 'serious' ‐ three out of four studies did not adequately explain randomisation methods; three studies rated 'high' on at least one risk of bias domain, including selective reporting and incomplete outcome data 10 Inconsistency: rated 'serious' ‐ heterogeneity was considerable (Chi² = 6.48, df = 3 (P = 0.09); I² = 54%). Suspected heterogeneity due to different comparator drugs used in all four studies (quetiapine; risperidone; timiperone; loxapine) 11 Control risk: median control group risk presented from the studies 12 Risk of bias: rated 'serious' ‐ randomisation methods not described in one out of the two studies (Kane 2003), this same study was funded by pharmaceutical companies, with all authors affiliated with either company 13 Indirectness: rated 'serious' ‐ one included study had five treatment arms (CATIE 2005)