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      Lurasidone, olanzapine, and quetiapine extended‐release for bipolar depression: A systematic review and network meta‐analysis of phase 3 trials in Japan

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          Abstract

          Aim

          This systematic review and random‐effect model, network meta‐analysis of the phase 3 trials in Japan assessed the efficacy and safety profile of lurasidone compared with olanzapine and quetiapine extended‐release (QUE‐XR) for the treatment of bipolar depression.

          Methods

          The study included double‐blind, randomized, placebo‐controlled, phase 3 trials in Japan that included patients with bipolar depression. Outcomes included response rate (primary), remission rate (secondary), improvement of Montgomery‐Åsberg Depression Rating Scale (MADRS) total score, discontinuation rates, and incidence of individual adverse events.

          Results

          Three studies were included (n = 1223). Lurasidone and olanzapine but not QUE‐XR were superior to placebo in response rate [risk ratio (95% credible interval): lurasidone = 0.78 (0.66, 0.92); olanzapine = 0.84 (0.71, 0.99); QUE‐XR = 0.87 (0.73, 1.03)]. Lurasidone, olanzapine and QUE‐XR were superior to placebo in remission rate [lurasidone = 0.90 (0.83, 0.98); olanzapine = 0.87 (0.77, 0.99); QUE‐XR = 0.84 (0.73, 0.98)] and the improvement of MADRS total score. There were not differences in discontinuation rates between each antipsychotic and placebo. Compared with placebo, lurasidone was higher incidence of akathisia, and increased body weight and blood prolactin level; olanzapine was higher incidence of somnolence and ≥7% weight gain, and increased body weight, blood total cholesterol level, blood LDL cholesterol level, and blood triglyceride levels; QUE‐XR was higher incidence of extrapyramidal symptoms, akathisia, somnolence, dry mouth, constipation and ≥7% weight gain, and increased body weight, blood total cholesterol level, blood LDL cholesterol level, and blood triglyceride levels.

          Conclusions

          Our results suggested although the efficacy of three SGAs was similar, there were the differences in the safety profile among the SGAs.

          Abstract

          The efficacy of three SGAs was similar. The safety profile was different in three SGAs.

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          Most cited references10

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            Meta-analysis in clinical trials.

            This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
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              Canadian Network for Mood and Anxiety Treatments ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder

              The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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                Author and article information

                Contributors
                tarok@fujita-hu.ac.jp
                Journal
                Neuropsychopharmacol Rep
                Neuropsychopharmacol Rep
                10.1002/(ISSN)2574-173X
                NPR2
                Neuropsychopharmacology Reports
                John Wiley and Sons Inc. (Hoboken )
                2574-173X
                09 September 2020
                December 2020
                : 40
                : 4 ( doiID: 10.1111/npr2.v40.4 )
                : 417-422
                Affiliations
                [ 1 ] Department of Psychiatry Fujita Health University School of Medicine Toyoake Japan
                [ 2 ] Department of Psychiatry University of Occupational and Environmental Health Kitakyushu Japan
                Author notes
                [*] [* ] Correspondence

                Taro Kishi, Department of Psychiatry, Fujita Health University School of Medicine, 1‐98 Dengakugakubo, Kutsukake‐cho, Toyoake, Aichi 470‐1192, Japan.

                Email: tarok@ 123456fujita-hu.ac.jp

                Author information
                https://orcid.org/0000-0002-9237-2236
                Article
                NPR212137
                10.1002/npr2.12137
                7722645
                32902200
                7582e888-c3f6-46a1-b96e-86a0221f0229
                © 2020 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsycho Pharmacology

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 June 2020
                : 14 August 2020
                : 17 August 2020
                Page count
                Figures: 1, Tables: 3, Pages: 6, Words: 3834
                Funding
                Funded by: Grant‐in‐Aid for Scientific Research (C)
                Award ID: 19K08082
                Categories
                Micro Report
                Micro Reports
                Custom metadata
                2.0
                December 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.5 mode:remove_FC converted:08.12.2020

                bipolar depression,efficacy/safety/tolerability,lurasidone,olanzapine,quetiapine extended‐release,systematic review and network meta‐analysis

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