Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials
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Abstract
The objective of this meta-analysis is to summarize the efficacy and tolerability
of the new antipsychotics risperidone, olanzapine, sertindole and quetiapine in schizophrenia
compared to placebo and conventional antipsychotics. The main results are: (1) All
of the 4 new drugs are more effective than placebo, but the magnitude of the effect
is only moderate [mean effect size, r, of all antipsychotics vs. placebo = 0.25, with
a 95% confidence interval (CI) = 0.22-0.28, n = 2477]. (2) According to the studies
published to date, sertindole and quetiapine are as effective as haloperidol, and
risperidone and olanzapine are slightly more effective than haloperidol in the treatment
of global schizophrenic symptomatology. (3) With respect to negative symptoms, all
new antipsychotics are more effective than placebo. However, contrary to widespread
opinion, so is the 'conventional' antipsychotic haloperidol. Risperidone and olanzapine
are slightly superior, sertindole is as effective and--according to the only study
fully published to date--quetiapine is even slightly less effective than haloperidol
in this regard. (4) All new antipsychotics are associated with less frequent use of
antiparkinson medication than haloperidol, with risperidone appearing to have a slightly
less favourable EPS-profile than the other new antipsychotics. The methodological
limitations of this review, the generalizability of the results and expectations from
future research are discussed.