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Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials
We conducted meta-analyses of findings from randomized, placebo-controlled, short-term trials for acute mania in manic or mixed states of DSM (III–IV) bipolar I disorder in 56 drug–placebo comparisons of 17 agents from 38 studies involving 10 800 patients. Of drugs tested, 13 (76%) were more effecti...
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| Published in: | Neuropsychopharmacology (New York, N.Y.) N.Y.), 2011-01, Vol.36 (2), p.375-389 |
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| creator | Yildiz, Ayşegül Vieta, Eduard Leucht, Stefan Baldessarini, Ross J |
| description | We conducted meta-analyses of findings from randomized, placebo-controlled, short-term trials for acute mania in manic or mixed states of DSM (III–IV) bipolar I disorder in 56 drug–placebo comparisons of 17 agents from 38 studies involving 10 800 patients. Of drugs tested, 13 (76%) were more effective than placebo: aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperdone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone. Their pooled effect size for mania improvement (Hedges’
g
in 48 trials) was 0.42 (confidence interval (CI): 0.36–0.48); pooled responder risk ratio (46 trials) was 1.52 (CI: 1.42–1.62); responder rate difference (RD) was 17% (drug: 48%, placebo: 31%), yielding an estimated number-needed-to-treat of 6 (all
p |
| doi_str_mv | 10.1038/npp.2010.192 |
| format | article |
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g
in 48 trials) was 0.42 (confidence interval (CI): 0.36–0.48); pooled responder risk ratio (46 trials) was 1.52 (CI: 1.42–1.62); responder rate difference (RD) was 17% (drug: 48%, placebo: 31%), yielding an estimated number-needed-to-treat of 6 (all
p
<0.0001). In several direct comparisons, responses to various antipsychotics were somewhat greater or more rapid than lithium, valproate, or carbamazepine; lithium did not differ from valproate, nor did second generation antipsychotics differ from haloperidol. Meta-regression associated higher study site counts, as well as subject number with greater placebo (not drug) response; and higher baseline mania score with greater drug (not placebo) response. Most effective agents had moderate effect-sizes (Hedges
’ g
=0.26–0.46); limited data indicated large effect sizes (Hedges
’ g
=0.51–2.32) for: carbamazepine, cariprazine, haloperidol, risperidone, and tamoxifen. The findings support the efficacy of most clinically used antimanic treatments, but encourage more head-to-head studies and development of agents with even greater efficacy.</description><identifier>ISSN: 0893-133X</identifier><identifier>EISSN: 1740-634X</identifier><identifier>DOI: 10.1038/npp.2010.192</identifier><identifier>PMID: 20980991</identifier><identifier>CODEN: NEROEW</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>631/92/436/108 ; 692/699/476/1333 ; Adult and adolescent clinical studies ; Antimanic Agents - pharmacology ; Antimanic Agents - therapeutic use ; Antipsychotic Agents - pharmacology ; Antipsychotic Agents - therapeutic use ; Behavioral Sciences ; Biological and medical sciences ; Biological Psychology ; Bipolar Disorder - drug therapy ; Humans ; Mania ; Medical sciences ; Medicine ; Medicine & Public Health ; Mood disorders ; Neuropharmacology ; Neurosciences ; Original ; original-article ; Outcome Assessment (Health Care) - methods ; Pharmacology. Drug treatments ; Pharmacotherapy ; Placebo Effect ; Psychiatry ; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer ; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) ; Psycholeptics: tranquillizer, neuroleptic ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychopharmacology ; Randomized Controlled Trials as Topic - methods ; Randomized Controlled Trials as Topic - trends ; Systematic review ; Time Factors ; Treatment Outcome</subject><ispartof>Neuropsychopharmacology (New York, N.Y.), 2011-01, Vol.36 (2), p.375-389</ispartof><rights>American College of Neuropsychopharmacology 2011</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Jan 2011</rights><rights>Copyright © 2011 American College of Neuropsychopharmacology 2011 American College of Neuropsychopharmacology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c601t-9fc0fd0ee48209496531cd18667b108907c9fd69e645c96073eb5a54cab79cd53</citedby><cites>FETCH-LOGICAL-c601t-9fc0fd0ee48209496531cd18667b108907c9fd69e645c96073eb5a54cab79cd53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055677/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055677/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23927181$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20980991$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yildiz, Ayşegül</creatorcontrib><creatorcontrib>Vieta, Eduard</creatorcontrib><creatorcontrib>Leucht, Stefan</creatorcontrib><creatorcontrib>Baldessarini, Ross J</creatorcontrib><title>Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials</title><title>Neuropsychopharmacology (New York, N.Y.)</title><addtitle>Neuropsychopharmacol</addtitle><addtitle>Neuropsychopharmacology</addtitle><description>We conducted meta-analyses of findings from randomized, placebo-controlled, short-term trials for acute mania in manic or mixed states of DSM (III–IV) bipolar I disorder in 56 drug–placebo comparisons of 17 agents from 38 studies involving 10 800 patients. Of drugs tested, 13 (76%) were more effective than placebo: aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperdone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone. Their pooled effect size for mania improvement (Hedges’
g
in 48 trials) was 0.42 (confidence interval (CI): 0.36–0.48); pooled responder risk ratio (46 trials) was 1.52 (CI: 1.42–1.62); responder rate difference (RD) was 17% (drug: 48%, placebo: 31%), yielding an estimated number-needed-to-treat of 6 (all
p
<0.0001). In several direct comparisons, responses to various antipsychotics were somewhat greater or more rapid than lithium, valproate, or carbamazepine; lithium did not differ from valproate, nor did second generation antipsychotics differ from haloperidol. Meta-regression associated higher study site counts, as well as subject number with greater placebo (not drug) response; and higher baseline mania score with greater drug (not placebo) response. Most effective agents had moderate effect-sizes (Hedges
’ g
=0.26–0.46); limited data indicated large effect sizes (Hedges
’ g
=0.51–2.32) for: carbamazepine, cariprazine, haloperidol, risperidone, and tamoxifen. The findings support the efficacy of most clinically used antimanic treatments, but encourage more head-to-head studies and development of agents with even greater efficacy.</description><subject>631/92/436/108</subject><subject>692/699/476/1333</subject><subject>Adult and adolescent clinical studies</subject><subject>Antimanic Agents - pharmacology</subject><subject>Antimanic Agents - therapeutic use</subject><subject>Antipsychotic Agents - pharmacology</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Behavioral Sciences</subject><subject>Biological and medical sciences</subject><subject>Biological Psychology</subject><subject>Bipolar Disorder - drug therapy</subject><subject>Humans</subject><subject>Mania</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mood disorders</subject><subject>Neuropharmacology</subject><subject>Neurosciences</subject><subject>Original</subject><subject>original-article</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacotherapy</subject><subject>Placebo Effect</subject><subject>Psychiatry</subject><subject>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer</subject><subject>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)</subject><subject>Psycholeptics: tranquillizer, neuroleptic</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychopharmacology</subject><subject>Randomized Controlled Trials as Topic - methods</subject><subject>Randomized Controlled Trials as Topic - trends</subject><subject>Systematic review</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0893-133X</issn><issn>1740-634X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqF0c1LHDEYBvAglrq1vXkugyC9ODYfk68eCrLYWlAsxYK3kM0kNjKTrMmMsP3rm2HXtS2IpxDymzdP5gHgAMETBIn4GJbLEwynncQ7YIZ4A2tGmptdMINCkhoRcrMH3uR8ByGinInXYA9DKaCUaAa-nznnjTarKrrqNAy-18Gb6jpZPfQ2DPlTdWkHXeugu1X2eWI_dGhj73_b9riaxzCk2HW2Ld943eW34JUri323WffBzy9n1_Pz-uLq67f56UVtGERDLZ2BroXWNqKEaSSjBJkWCcb4ApXckBvpWiYta6iRDHJiF1TTxugFl6alZB98Xs9djovetqZkTbpTy1RekFYqaq_-PQn-l7qND4pAShnnZcCHzYAU70ebB9X7bGzX6WDjmFWJgCjFjL0oBUaNELQhRR7-J-_imMqvK4hggjnH07jjNTIp5pys24ZGUE2VqlKpmipVpdLC3__90C1-7LCAow3Q2ejOJR2Mz0-OSMyRmFy9drkchVubnsI9c3G19kEPY7LbgQVNZiJ_AEEEw0g</recordid><startdate>20110101</startdate><enddate>20110101</enddate><creator>Yildiz, Ayşegül</creator><creator>Vieta, Eduard</creator><creator>Leucht, Stefan</creator><creator>Baldessarini, Ross J</creator><general>Springer International Publishing</general><general>Nature Publishing Group</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110101</creationdate><title>Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials</title><author>Yildiz, Ayşegül ; Vieta, Eduard ; Leucht, Stefan ; Baldessarini, Ross J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c601t-9fc0fd0ee48209496531cd18667b108907c9fd69e645c96073eb5a54cab79cd53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>631/92/436/108</topic><topic>692/699/476/1333</topic><topic>Adult and adolescent clinical studies</topic><topic>Antimanic Agents - pharmacology</topic><topic>Antimanic Agents - therapeutic use</topic><topic>Antipsychotic Agents - pharmacology</topic><topic>Antipsychotic Agents - therapeutic use</topic><topic>Behavioral Sciences</topic><topic>Biological and medical sciences</topic><topic>Biological Psychology</topic><topic>Bipolar Disorder - drug therapy</topic><topic>Humans</topic><topic>Mania</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mood disorders</topic><topic>Neuropharmacology</topic><topic>Neurosciences</topic><topic>Original</topic><topic>original-article</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Pharmacology. 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Of drugs tested, 13 (76%) were more effective than placebo: aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperdone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone. Their pooled effect size for mania improvement (Hedges’
g
in 48 trials) was 0.42 (confidence interval (CI): 0.36–0.48); pooled responder risk ratio (46 trials) was 1.52 (CI: 1.42–1.62); responder rate difference (RD) was 17% (drug: 48%, placebo: 31%), yielding an estimated number-needed-to-treat of 6 (all
p
<0.0001). In several direct comparisons, responses to various antipsychotics were somewhat greater or more rapid than lithium, valproate, or carbamazepine; lithium did not differ from valproate, nor did second generation antipsychotics differ from haloperidol. Meta-regression associated higher study site counts, as well as subject number with greater placebo (not drug) response; and higher baseline mania score with greater drug (not placebo) response. Most effective agents had moderate effect-sizes (Hedges
’ g
=0.26–0.46); limited data indicated large effect sizes (Hedges
’ g
=0.51–2.32) for: carbamazepine, cariprazine, haloperidol, risperidone, and tamoxifen. The findings support the efficacy of most clinically used antimanic treatments, but encourage more head-to-head studies and development of agents with even greater efficacy.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>20980991</pmid><doi>10.1038/npp.2010.192</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Neuropsychopharmacology (New York, N.Y.), 2011-01, Vol.36 (2), p.375-389 |
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| subjects | 631/92/436/108 692/699/476/1333 Adult and adolescent clinical studies Antimanic Agents - pharmacology Antimanic Agents - therapeutic use Antipsychotic Agents - pharmacology Antipsychotic Agents - therapeutic use Behavioral Sciences Biological and medical sciences Biological Psychology Bipolar Disorder - drug therapy Humans Mania Medical sciences Medicine Medicine & Public Health Mood disorders Neuropharmacology Neurosciences Original original-article Outcome Assessment (Health Care) - methods Pharmacology. Drug treatments Pharmacotherapy Placebo Effect Psychiatry Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) Psycholeptics: tranquillizer, neuroleptic Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychopharmacology Randomized Controlled Trials as Topic - methods Randomized Controlled Trials as Topic - trends Systematic review Time Factors Treatment Outcome |
| title | Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials |
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