First- and Second-Generation Antipsychotics for Children and Young Adults
Efficacy of Second-Generation Antipsychotics: Placebo Comparisons, by Indication (1 of 3)
Second-generation antipsychotics (SGAs) have been compared to placebo to evaluate the clinical benefit achieved with their use.
In treatment of bipolar disorder, a meta-analysis of 6 studies of 978 participants shows that the Clinical Global Impression (CGI) score is 0.67 points lower with SGAs (0.51 to 0.84 points lower). The strength of evidence for this finding is moderate.
There is a significant degree of statistical heterogeneity among the studies of SGAs evaluated using the Young Mania Rating Scale (YMRS). In 3 studies of 328 participants, scores with aripiprazole treatment were 7.22 points lower than placebo (valid range from 5.17 to 9.28 points lower). In 1 study of 159 participants, scores with olanzapine treatment were 7.66 points lower than with placebo (valid range from 5.68 to 9.74 points lower). In 3 studies of 339 participants, scores with quetiapine treatment were significantly statistically heterogeneous and were not combined for meta-analysis. In 1 study of 163 participants, scores with risperidone treatment were 8.31 points lower than placebo (valid range from 4.88 to 11.74 points lower). In 1 study of 218 participants, scores with ziprasidone treatment were 5.22 points lower than placebo (valid range from 2.36 to 8.08 points lower). The strength of evidence is low for these findings using the YMRS to evaluate outcomes.
Four studies of SGAs measured outcomes on the Children’s Depression Rating Scale (CDRS) for 532 participants. No statistically significant difference was noted in any individual study, but a meta-analysis was not performed due to statistical heterogeneity. The strength of evidence is low.
Statistical Abbreviations: 95% CI = 95-percent confidence interval; NSD = no statistically significant difference
- Seida J, Schouten J, Mousavi S, et al. First- and Second-Generation Antipsychotics for Children and Young Adults. Comparative Effectiveness Review No. 39 (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-2007-10021). Rockville, MD: Agency for Healthcare Research and Quality; February 2012. AHRQ Publication No. 11(12)-EHC077-EF. Available at www.effectivehealthcare.ahrq.gov/pedantipsych.cfm.
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