Efficacy and safety of lithium and lamotrigine for the maintenance treatment of clinically stable patients with bipolar disorder: A systematic review and meta‐analysis of double‐blind, randomized, placebo‐controlled trials with an enrichment design

Aim Whether patients with adult bipolar disorder (BD) who have been clinically stabilized with lithium or lamotrigine should continue this medication is not established fully. This systematic review and meta‐analysis evaluated the efficacy and safety of lithium and lamotrigine for maintenance treatm...

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Published in:Neuropsychopharmacology reports 2019-09, Vol.39 (3), p.241-246
Main Authors: Oya, Kazuto, Sakuma, Kenji, Esumi, Satoru, Hashimoto, Yasuhiko, Hatano, Masakazu, Matsuda, Yuki, Matsui, Yuki, Miyake, Nobumi, Nomura, Ikuo, Okuya, Makoto, Iwata, Nakao, Kato, Masaki, Hashimoto, Ryota, Mishima, Kazuo, Watanabe, Norio, Kishi, Taro
Format: Article
Language:English
Subjects:
Age
Bias
Bipolar disorder
Double-blind studies
Drug dosages
Grants
lamotrigine
Lithium
Meta-analysis
Micro Report
Micro Reports
Studies
Systematic review
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Summary:Aim Whether patients with adult bipolar disorder (BD) who have been clinically stabilized with lithium or lamotrigine should continue this medication is not established fully. This systematic review and meta‐analysis evaluated the efficacy and safety of lithium and lamotrigine for maintenance treatment in clinically stable patients with adult BD. Methods This meta‐analysis included only double‐blind, randomized, placebo‐controlled trials with an enrichment design that selected patients who responded acutely to lithium or lamotrigine. Reports prior to November 15, 2018, were retrieved from the PubMed/Cochrane Library/Embase. The primary outcome was the relapse rate due to any mood episode at the study endpoint. Other outcomes were relapse rates due to a manic/hypomanic/mixed episode or depression at the study endpoint, discontinuation rate, death, and death by suicide. Risk ratios (RRs) (95% confidence intervals) were calculated. When the random‐effects model showed significant differences between groups, the number‐needed‐to‐treat (NNT) was estimated. Results The search retrieved two studies regarding lithium (N = 218) and four evaluating lamotrigine (N = 706). Both drugs were superior to placebo for reducing the relapse rate due to any mood episode [lithium: RR = 0.52 (0.41‐0.66), P 
ISSN:2574-173X
2574-173X
DOI:10.1002/npr2.12056