TY - JOUR
T1 - Antipsychotics for primary alcohol dependence
T2 - A systematic review and meta-analysis of placebo-controlled trials
AU - Kishi, Taro
AU - Sevy, Serge
AU - Chekuri, Raja
AU - Correll, Christoph U.
N1 - Funding Information:
This work was partially supported by National Basic Research Program of China (973 Program No. 2013CB338001), National Natural Science Foundation of China (No. 61602476, No. 61402470) and Strategy Pilot Project of Chinese Academy of Sciences (No. XDA06010702).
PY - 2013/7
Y1 - 2013/7
N2 - Objective: We sought to meta-analytically assess the utility of antipsychotics in patients with primary alcohol dependence. DataSources:We searched PubMed, Cochrane Library, and PsycINFO without language restrictions from database inception until December2012, using the following keywords: (randomized, random, OR randomly) AND (placebo) AND ca/co hol dependence) AND (neuro/eptic OR antipsychotic OR antidopaminergic OR the names of 34 individual a nti psychotics). StudySelection: Included in this study were randomized, placebo- controlled trials of antipsychotics lasting >2 weeks in patients with primary alcohol dependence and without schizophrenia or bipolar disorder. Data Extraction:Two independent evaluators extracted data. Standardized mean difference (SMD), risk ratio (RR), and numbers needed to harm (NNH) +95°c confidence intervals (CIs) were calculated. Results: Across 3 double-blind studies, 593 piens were rdndorllly assigned to one of the following: amisulpride (1 study, n=37), aripiprazole (2 studies, n=163), flupenthixol decanoate (1 study, n=142), olanzapine (2 studies, n=62), quetiapine (4 studies, n=174), tiapride (3 studies, n=212), or placebo (13 studies, n=803). Neither pooled nor individual antipsychotics outperformed placebo regarding relapse prevention (pooled RR=1.05 [95% Cl, 0.95 to 1.16], P=.38, 9 studies, n=1,405). Antipsychotics were similar to placebo regarding heavy drinking days (P=.15), craving (P=.82), and first alcohol consumption time (P=.94). Placebo outperformed pooled antipsychotics regarding number or percentage of abstinent days/lack of drinking days (SMD 0.17 [95% Cl, QQ1 to 0.33], P=.04, 5 studies, n=918), without significant group differences after removal of 1 outlying flupenthixol decanoate study (P=.24). Individually, flupenthixol decanoate (1 study, n=281) was inferior to placebo regarding abstinence/drinking days (P=.004), whereas aripiprazole (1 study, n=30) was superior regarding heavy drinking days (P< .00001). Antipsychotics caused greater all-cause discontinuation than placebo (RR=1.24 [95% Cl, 1.07 to 1.45], P=.005, NNH 14), especially aripiprazole (P=.01) and flupenthixol decanoate (P=.001). Discontinuation due to intolerability was similar between antipsychotics and placebo (P=.12), but aripiprazole's risk was higher (P=.003). Drowsiness/sedation (P< .0001, NNH 9), increased appetite (P=.02, NNH 14, and dry mouth (P< .0001, NNH 7 occurred more frequently with pooled antipsychotics. Conclusions: Except for 1 isolated outcome, the studied antipsychotics did not improve abstinence or reduce drinking or craving in patients with primary alcohol dependence.
AB - Objective: We sought to meta-analytically assess the utility of antipsychotics in patients with primary alcohol dependence. DataSources:We searched PubMed, Cochrane Library, and PsycINFO without language restrictions from database inception until December2012, using the following keywords: (randomized, random, OR randomly) AND (placebo) AND ca/co hol dependence) AND (neuro/eptic OR antipsychotic OR antidopaminergic OR the names of 34 individual a nti psychotics). StudySelection: Included in this study were randomized, placebo- controlled trials of antipsychotics lasting >2 weeks in patients with primary alcohol dependence and without schizophrenia or bipolar disorder. Data Extraction:Two independent evaluators extracted data. Standardized mean difference (SMD), risk ratio (RR), and numbers needed to harm (NNH) +95°c confidence intervals (CIs) were calculated. Results: Across 3 double-blind studies, 593 piens were rdndorllly assigned to one of the following: amisulpride (1 study, n=37), aripiprazole (2 studies, n=163), flupenthixol decanoate (1 study, n=142), olanzapine (2 studies, n=62), quetiapine (4 studies, n=174), tiapride (3 studies, n=212), or placebo (13 studies, n=803). Neither pooled nor individual antipsychotics outperformed placebo regarding relapse prevention (pooled RR=1.05 [95% Cl, 0.95 to 1.16], P=.38, 9 studies, n=1,405). Antipsychotics were similar to placebo regarding heavy drinking days (P=.15), craving (P=.82), and first alcohol consumption time (P=.94). Placebo outperformed pooled antipsychotics regarding number or percentage of abstinent days/lack of drinking days (SMD 0.17 [95% Cl, QQ1 to 0.33], P=.04, 5 studies, n=918), without significant group differences after removal of 1 outlying flupenthixol decanoate study (P=.24). Individually, flupenthixol decanoate (1 study, n=281) was inferior to placebo regarding abstinence/drinking days (P=.004), whereas aripiprazole (1 study, n=30) was superior regarding heavy drinking days (P< .00001). Antipsychotics caused greater all-cause discontinuation than placebo (RR=1.24 [95% Cl, 1.07 to 1.45], P=.005, NNH 14), especially aripiprazole (P=.01) and flupenthixol decanoate (P=.001). Discontinuation due to intolerability was similar between antipsychotics and placebo (P=.12), but aripiprazole's risk was higher (P=.003). Drowsiness/sedation (P< .0001, NNH 9), increased appetite (P=.02, NNH 14, and dry mouth (P< .0001, NNH 7 occurred more frequently with pooled antipsychotics. Conclusions: Except for 1 isolated outcome, the studied antipsychotics did not improve abstinence or reduce drinking or craving in patients with primary alcohol dependence.
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U2 - 10.4088/JCP.12r08178
DO - 10.4088/JCP.12r08178
M3 - Article
C2 - 23945459
AN - SCOPUS:84880967051
SN - 0160-6689
VL - 74
SP - e642-e654
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
IS - 7
ER -