Abstract
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 < 0.00001, I2 = 0%, NNT = 2.3 (1.6-4.2); lamotrigine: RR = 0.81 (0.70-0.93), P = 0.004, I2 = 0%, NNT = 8.3 (5.0-25.0)] and all-cause discontinuation. There were no significant differences in other outcomes between lithium or lamotrigine and the placebo groups. Conclusion: Both drugs showed benefit for preventing relapse in clinically stable patients with adult BD. However, the number of studies and patients in this analysis was small.
| Original language | English |
|---|---|
| Pages (from-to) | 241-246 |
| Number of pages | 6 |
| Journal | Neuropsychopharmacology reports |
| Volume | 39 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 01-09-2019 |
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All Science Journal Classification (ASJC) codes
- Clinical Psychology
- Pharmacology
- Psychiatry and Mental health
- Pharmacology (medical)
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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. / 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.
In: Neuropsychopharmacology reports, Vol. 39, No. 3, 01.09.2019, p. 241-246.Research output: Contribution to journal › Article
TY - JOUR
T1 - Efficacy and safety of lithium and lamotrigine for the maintenance treatment of clinically stable patients with bipolar disorder
T2 - A systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials with an enrichment design
AU - Oya, Kazuto
AU - Sakuma, Kenji
AU - Esumi, Satoru
AU - Hashimoto, Yasuhiko
AU - Hatano, Masakazu
AU - Matsuda, Yuki
AU - Matsui, Yuki
AU - Miyake, Nobumi
AU - Nomura, Ikuo
AU - Okuya, Makoto
AU - Iwata, Nakao
AU - Kato, Masaki
AU - Hashimoto, Ryota
AU - Mishima, Kazuo
AU - Watanabe, Norio
AU - Kishi, Taro
PY - 2019/9/1
Y1 - 2019/9/1
N2 - 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 < 0.00001, I2 = 0%, NNT = 2.3 (1.6-4.2); lamotrigine: RR = 0.81 (0.70-0.93), P = 0.004, I2 = 0%, NNT = 8.3 (5.0-25.0)] and all-cause discontinuation. There were no significant differences in other outcomes between lithium or lamotrigine and the placebo groups. Conclusion: Both drugs showed benefit for preventing relapse in clinically stable patients with adult BD. However, the number of studies and patients in this analysis was small.
AB - 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 < 0.00001, I2 = 0%, NNT = 2.3 (1.6-4.2); lamotrigine: RR = 0.81 (0.70-0.93), P = 0.004, I2 = 0%, NNT = 8.3 (5.0-25.0)] and all-cause discontinuation. There were no significant differences in other outcomes between lithium or lamotrigine and the placebo groups. Conclusion: Both drugs showed benefit for preventing relapse in clinically stable patients with adult BD. However, the number of studies and patients in this analysis was small.
UR - http://www.scopus.com/inward/record.url?scp=85071784836&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071784836&partnerID=8YFLogxK
U2 - 10.1002/npr2.12056
DO - 10.1002/npr2.12056
M3 - Article
C2 - 31026388
AN - SCOPUS:85071784836
VL - 39
SP - 241
EP - 246
JO - Neuropsychopharmacology Reports
JF - Neuropsychopharmacology Reports
SN - 1340-2544
IS - 3
ER -