Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis
Summary: Background: Acute mania is a psychiatric emergency requiring rapid management. However, randomised controlled trials (RCTs) have shown considerable individual differences in treatment effects on manic symptoms with antimanic drugs. Methods: We searched the MEDLINE, CENTRAL, EMBASE, PsycINF...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022004205 |
| _version_ | 1817967843665248256 |
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| author | Tien-Wei Hsu Trevor Thompson Marco Solmi Eduard Vieta Fu-Chi Yang Ping-Tao Tseng Chih-Wei Hsu Yu-Kang Tu Chia-Ling Yu Chia-Kuang Tsai Chih-Sung Liang Andre F. Carvalho |
| author_facet | Tien-Wei Hsu Trevor Thompson Marco Solmi Eduard Vieta Fu-Chi Yang Ping-Tao Tseng Chih-Wei Hsu Yu-Kang Tu Chia-Ling Yu Chia-Kuang Tsai Chih-Sung Liang Andre F. Carvalho |
| author_sort | Tien-Wei Hsu |
| collection | DOAJ |
| description | Summary: Background: Acute mania is a psychiatric emergency requiring rapid management. However, randomised controlled trials (RCTs) have shown considerable individual differences in treatment effects on manic symptoms with antimanic drugs. Methods: We searched the MEDLINE, CENTRAL, EMBASE, PsycINFO, and ClinicalTrials.gov to identify RCTs without language restrictions from inception to April 19, 2022. We included double-blind RCTs of oral antimanic monotherapy versus placebo in adult patients. The primary outcome was variability in improvement of manic symptoms (assessed using the coefficient of variation ratio [CVR]). The secondary outcomes were overall improvement of manic symptoms and acceptability (i.e., discontinuation for any reason). The pooled effects of outcomes were calculated by random-effects meta-analyses using restricted maximum likelihood methods. The quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) Assessment Tool. This study was registered with OSF (DOI:10.17605/OSF.IO/G4JNY). Findings: We included 39 RCTs (N=12150; mean age=39·9 years, interquartile range [IQR]=38·7-41·1; mean proportion of female=48·6%, IQR=42·3%-52·3%) and investigated 14 antimanic drugs. We found that eight antimanic drugs compared to placebo were associated with lower CVRs (95% confidence interval [CI]; I2), including risperidone (0·51; 0·37-0·70; 0%), haloperidol (0·54; 0·44-0·67; 4%), olanzapine (0·59; 0·44-0·79; 47%), ziprasidone (0·61; 0·53-0·71; 0%), lithium (0·63; 0·52-0·76; 0%), quetiapine (0·65; 0·48-0·87; 2%), aripiprazole (0·68; 0·56-0·84; 25%), and cariprazine (0·70; 0·49-0·99; 28%). There were nine antimanic drugs associated with greater efficacy than placebo, including risperidone (reported as standardised mean difference; 95% CI; I2: 0·64; 0·31-0·97; 15%), haloperidol (0·57; 0·29-0·85; 64%), cariprazine (0·51; 0·24-0·78; 0%), olanzapine (0·44; 0·30-0·58; 0%), lithium (0·42; 0·29-0·55; 0%), ziprasidone (0·42; 0·26-0·58; 0%), quetiapine (0·40; 0·13-0·67; 0%), asenapine (0·40; 0·13-0·67; 0%), and aripiprazole (0·32; 0·14-0·49; 53%). Ziprasidone (reported as risk ratio; 95% CI; I2: 0·83; 0·79-0·89; 0%) and olanzapine (0·63; 0·49-0·80; 35%) were associated with better acceptability relative to placebo. Among the 39 RCTs, none had a high ROB. Interpretation: We demonstrated that eight antimanic drugs were associated with lower variability and better efficacy than placebo, suggesting that these antimanic drugs were associated with more homogenous and predictable improvements of manic symptoms in patients with acute mania. Funding: The study was supported by from the Ministry of Science and Technology (MOST-110-2314-B-016-035, MOST-111-2314-B-016-054), Medical Affairs Bureau (MND-MAB-D-111102), and Tri-service General Hospital (TSGH-E-111229). |
| first_indexed | 2024-04-12T00:46:20Z |
| format | Article |
| id | doaj.art-994a62bc9e9d417183bceb7d084a66d0 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-12T00:46:20Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-994a62bc9e9d417183bceb7d084a66d02022-12-22T03:54:52ZengElsevierEClinicalMedicine2589-53702022-12-0154101690Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysisTien-Wei Hsu0Trevor Thompson1Marco Solmi2Eduard Vieta3Fu-Chi Yang4Ping-Tao Tseng5Chih-Wei Hsu6Yu-Kang Tu7Chia-Ling Yu8Chia-Kuang Tsai9Chih-Sung Liang10Andre F. Carvalho11Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanCentre for Chronic Illness and Ageing, University of Greenwich, London, UKDepartment of Psychiatry, University of Ottawa, Ottawa, ON K1N 6N5, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada; Clinical Epidemiology Programme, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON K1N 6N5, CanadaCentro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital Clinic, Institute of Neuroscience, Universityof Barcelona, IDIBAPS, Barcelona, SpainDepartment of Neurology, Tri-Service General Hospital, National Defence Medical Centre, Taipei, TaiwanProspect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, TaiwanDepartment of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanInstitute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, TaiwanDepartment of Pharmacy, Chang-Gung Memorial Hospital, Linkou, TaiwanDepartment of Neurology, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan; Corresponding author at: Department of Neurology, Tri-Service General Hospital, National Defence Medical Centre, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei City 114, Taiwan.Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan; Department of Psychiatry, National Defence Medical Centre, Taipei, Taiwan; Corresponding author at: Department of Psychiatry, No. 60, Xinmin Road, Beitou District, Taipei 11243, Taiwan.IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, AustraliaSummary: Background: Acute mania is a psychiatric emergency requiring rapid management. However, randomised controlled trials (RCTs) have shown considerable individual differences in treatment effects on manic symptoms with antimanic drugs. Methods: We searched the MEDLINE, CENTRAL, EMBASE, PsycINFO, and ClinicalTrials.gov to identify RCTs without language restrictions from inception to April 19, 2022. We included double-blind RCTs of oral antimanic monotherapy versus placebo in adult patients. The primary outcome was variability in improvement of manic symptoms (assessed using the coefficient of variation ratio [CVR]). The secondary outcomes were overall improvement of manic symptoms and acceptability (i.e., discontinuation for any reason). The pooled effects of outcomes were calculated by random-effects meta-analyses using restricted maximum likelihood methods. The quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) Assessment Tool. This study was registered with OSF (DOI:10.17605/OSF.IO/G4JNY). Findings: We included 39 RCTs (N=12150; mean age=39·9 years, interquartile range [IQR]=38·7-41·1; mean proportion of female=48·6%, IQR=42·3%-52·3%) and investigated 14 antimanic drugs. We found that eight antimanic drugs compared to placebo were associated with lower CVRs (95% confidence interval [CI]; I2), including risperidone (0·51; 0·37-0·70; 0%), haloperidol (0·54; 0·44-0·67; 4%), olanzapine (0·59; 0·44-0·79; 47%), ziprasidone (0·61; 0·53-0·71; 0%), lithium (0·63; 0·52-0·76; 0%), quetiapine (0·65; 0·48-0·87; 2%), aripiprazole (0·68; 0·56-0·84; 25%), and cariprazine (0·70; 0·49-0·99; 28%). There were nine antimanic drugs associated with greater efficacy than placebo, including risperidone (reported as standardised mean difference; 95% CI; I2: 0·64; 0·31-0·97; 15%), haloperidol (0·57; 0·29-0·85; 64%), cariprazine (0·51; 0·24-0·78; 0%), olanzapine (0·44; 0·30-0·58; 0%), lithium (0·42; 0·29-0·55; 0%), ziprasidone (0·42; 0·26-0·58; 0%), quetiapine (0·40; 0·13-0·67; 0%), asenapine (0·40; 0·13-0·67; 0%), and aripiprazole (0·32; 0·14-0·49; 53%). Ziprasidone (reported as risk ratio; 95% CI; I2: 0·83; 0·79-0·89; 0%) and olanzapine (0·63; 0·49-0·80; 35%) were associated with better acceptability relative to placebo. Among the 39 RCTs, none had a high ROB. Interpretation: We demonstrated that eight antimanic drugs were associated with lower variability and better efficacy than placebo, suggesting that these antimanic drugs were associated with more homogenous and predictable improvements of manic symptoms in patients with acute mania. Funding: The study was supported by from the Ministry of Science and Technology (MOST-110-2314-B-016-035, MOST-111-2314-B-016-054), Medical Affairs Bureau (MND-MAB-D-111102), and Tri-service General Hospital (TSGH-E-111229).http://www.sciencedirect.com/science/article/pii/S2589537022004205Bipolar maniaVariability in improvement of manic symptomsMeta-analysisAntipsychoticsMood stabilisersAnticonvulsants |
| spellingShingle | Tien-Wei Hsu Trevor Thompson Marco Solmi Eduard Vieta Fu-Chi Yang Ping-Tao Tseng Chih-Wei Hsu Yu-Kang Tu Chia-Ling Yu Chia-Kuang Tsai Chih-Sung Liang Andre F. Carvalho Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis EClinicalMedicine Bipolar mania Variability in improvement of manic symptoms Meta-analysis Antipsychotics Mood stabilisers Anticonvulsants |
| title | Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis |
| title_full | Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis |
| title_fullStr | Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis |
| title_full_unstemmed | Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis |
| title_short | Variability and efficacy in treatment effects on manic symptoms with lithium, anticonvulsants, and antipsychotics in acute bipolar mania: A systematic review and meta-analysis |
| title_sort | variability and efficacy in treatment effects on manic symptoms with lithium anticonvulsants and antipsychotics in acute bipolar mania a systematic review and meta analysis |
| topic | Bipolar mania Variability in improvement of manic symptoms Meta-analysis Antipsychotics Mood stabilisers Anticonvulsants |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022004205 |
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