Folic acid/methylfolate for the treatment of psychopathology in schizophrenia: a systematic review and meta-analysis

Kenji Sakuma, Shinji Matsunaga, Ikuo Nomura, Makoto Okuya, Taro Kishi, Nakao Iwata

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Rationale: This study aims to examine whether folate/folic acid/methylfolate/folinic acid supplemented to antipsychotics (FA + AP) is beneficial in schizophrenia treatment. Objective: We conducted a comprehensive systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials (RCTs) of FA + AP for schizophrenia. Methods: The primary outcome was an improvement in total symptoms. Other outcomes were psychopathology subscales (positive, negative, general, and depressive symptoms), discontinuation due to all-cause and adverse events, and individual adverse events. The meta-analysis evaluated the effect size based on a random-effects model. Results: Although we included ten RCTs with 925 patients in total (seven folic acid RCTs (n = 789), two methylfolate RCTs (n = 96), and one folinic acid RCT (n = 40)) in the systematic review, only seven RCTs were included in the meta-analysis. Pooled FA + AP treatments were not superior to placebo + AP in the improvement of total (N = 7, n = 340; standardized mean difference (SMD) = − 0.20, 95% confidence interval (CI) = − 0.41, 0.02, p = 0.08, I 2  = 0%), positive, general, or depressive symptoms. Pooled FA + AP treatments were more effective than placebo + AP for negative symptoms (N = 5, n = 281; SMD = −0.25, 95% CI = −0.49, −0.01, p = 0.04, I 2  = 0%). Although pooled FA + AP treatments were associated with a lower incidence of serious adverse events than placebo treatments (N = 4, n = 241; risk ratio = 0.32, 95% CI = 0.12–0.82, p = 0.02, I 2  = 0%; number needed to harm = not significant), there were no significant differences in other safety outcomes between both treatments. Conclusions: Our findings suggest that pooled FA + AP treatment improves negative symptoms in schizophrenia patients. Moreover, this treatment was well tolerated. However, because our results might exhibit a small-study effect, future studies with a larger sample should be conducted to obtain more robust results.

Original languageEnglish
Pages (from-to)2303-2314
Number of pages12
JournalPsychopharmacology
Volume235
Issue number8
DOIs
Publication statusPublished - 01-08-2018

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Psychopathology
Folic Acid
Meta-Analysis
Schizophrenia
Randomized Controlled Trials
Placebos
Leucovorin
Confidence Intervals
Therapeutics
Depression
Antipsychotic Agents
Odds Ratio
Safety
Incidence

All Science Journal Classification (ASJC) codes

  • Pharmacology

Cite this

Sakuma, Kenji ; Matsunaga, Shinji ; Nomura, Ikuo ; Okuya, Makoto ; Kishi, Taro ; Iwata, Nakao. / Folic acid/methylfolate for the treatment of psychopathology in schizophrenia : a systematic review and meta-analysis. In: Psychopharmacology. 2018 ; Vol. 235, No. 8. pp. 2303-2314.
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title = "Folic acid/methylfolate for the treatment of psychopathology in schizophrenia: a systematic review and meta-analysis",
abstract = "Rationale: This study aims to examine whether folate/folic acid/methylfolate/folinic acid supplemented to antipsychotics (FA + AP) is beneficial in schizophrenia treatment. Objective: We conducted a comprehensive systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials (RCTs) of FA + AP for schizophrenia. Methods: The primary outcome was an improvement in total symptoms. Other outcomes were psychopathology subscales (positive, negative, general, and depressive symptoms), discontinuation due to all-cause and adverse events, and individual adverse events. The meta-analysis evaluated the effect size based on a random-effects model. Results: Although we included ten RCTs with 925 patients in total (seven folic acid RCTs (n = 789), two methylfolate RCTs (n = 96), and one folinic acid RCT (n = 40)) in the systematic review, only seven RCTs were included in the meta-analysis. Pooled FA + AP treatments were not superior to placebo + AP in the improvement of total (N = 7, n = 340; standardized mean difference (SMD) = − 0.20, 95{\%} confidence interval (CI) = − 0.41, 0.02, p = 0.08, I 2  = 0{\%}), positive, general, or depressive symptoms. Pooled FA + AP treatments were more effective than placebo + AP for negative symptoms (N = 5, n = 281; SMD = −0.25, 95{\%} CI = −0.49, −0.01, p = 0.04, I 2  = 0{\%}). Although pooled FA + AP treatments were associated with a lower incidence of serious adverse events than placebo treatments (N = 4, n = 241; risk ratio = 0.32, 95{\%} CI = 0.12–0.82, p = 0.02, I 2  = 0{\%}; number needed to harm = not significant), there were no significant differences in other safety outcomes between both treatments. Conclusions: Our findings suggest that pooled FA + AP treatment improves negative symptoms in schizophrenia patients. Moreover, this treatment was well tolerated. However, because our results might exhibit a small-study effect, future studies with a larger sample should be conducted to obtain more robust results.",
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Folic acid/methylfolate for the treatment of psychopathology in schizophrenia : a systematic review and meta-analysis. / Sakuma, Kenji; Matsunaga, Shinji; Nomura, Ikuo; Okuya, Makoto; Kishi, Taro; Iwata, Nakao.

In: Psychopharmacology, Vol. 235, No. 8, 01.08.2018, p. 2303-2314.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Folic acid/methylfolate for the treatment of psychopathology in schizophrenia

T2 - a systematic review and meta-analysis

AU - Sakuma, Kenji

AU - Matsunaga, Shinji

AU - Nomura, Ikuo

AU - Okuya, Makoto

AU - Kishi, Taro

AU - Iwata, Nakao

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Rationale: This study aims to examine whether folate/folic acid/methylfolate/folinic acid supplemented to antipsychotics (FA + AP) is beneficial in schizophrenia treatment. Objective: We conducted a comprehensive systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials (RCTs) of FA + AP for schizophrenia. Methods: The primary outcome was an improvement in total symptoms. Other outcomes were psychopathology subscales (positive, negative, general, and depressive symptoms), discontinuation due to all-cause and adverse events, and individual adverse events. The meta-analysis evaluated the effect size based on a random-effects model. Results: Although we included ten RCTs with 925 patients in total (seven folic acid RCTs (n = 789), two methylfolate RCTs (n = 96), and one folinic acid RCT (n = 40)) in the systematic review, only seven RCTs were included in the meta-analysis. Pooled FA + AP treatments were not superior to placebo + AP in the improvement of total (N = 7, n = 340; standardized mean difference (SMD) = − 0.20, 95% confidence interval (CI) = − 0.41, 0.02, p = 0.08, I 2  = 0%), positive, general, or depressive symptoms. Pooled FA + AP treatments were more effective than placebo + AP for negative symptoms (N = 5, n = 281; SMD = −0.25, 95% CI = −0.49, −0.01, p = 0.04, I 2  = 0%). Although pooled FA + AP treatments were associated with a lower incidence of serious adverse events than placebo treatments (N = 4, n = 241; risk ratio = 0.32, 95% CI = 0.12–0.82, p = 0.02, I 2  = 0%; number needed to harm = not significant), there were no significant differences in other safety outcomes between both treatments. Conclusions: Our findings suggest that pooled FA + AP treatment improves negative symptoms in schizophrenia patients. Moreover, this treatment was well tolerated. However, because our results might exhibit a small-study effect, future studies with a larger sample should be conducted to obtain more robust results.

AB - Rationale: This study aims to examine whether folate/folic acid/methylfolate/folinic acid supplemented to antipsychotics (FA + AP) is beneficial in schizophrenia treatment. Objective: We conducted a comprehensive systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials (RCTs) of FA + AP for schizophrenia. Methods: The primary outcome was an improvement in total symptoms. Other outcomes were psychopathology subscales (positive, negative, general, and depressive symptoms), discontinuation due to all-cause and adverse events, and individual adverse events. The meta-analysis evaluated the effect size based on a random-effects model. Results: Although we included ten RCTs with 925 patients in total (seven folic acid RCTs (n = 789), two methylfolate RCTs (n = 96), and one folinic acid RCT (n = 40)) in the systematic review, only seven RCTs were included in the meta-analysis. Pooled FA + AP treatments were not superior to placebo + AP in the improvement of total (N = 7, n = 340; standardized mean difference (SMD) = − 0.20, 95% confidence interval (CI) = − 0.41, 0.02, p = 0.08, I 2  = 0%), positive, general, or depressive symptoms. Pooled FA + AP treatments were more effective than placebo + AP for negative symptoms (N = 5, n = 281; SMD = −0.25, 95% CI = −0.49, −0.01, p = 0.04, I 2  = 0%). Although pooled FA + AP treatments were associated with a lower incidence of serious adverse events than placebo treatments (N = 4, n = 241; risk ratio = 0.32, 95% CI = 0.12–0.82, p = 0.02, I 2  = 0%; number needed to harm = not significant), there were no significant differences in other safety outcomes between both treatments. Conclusions: Our findings suggest that pooled FA + AP treatment improves negative symptoms in schizophrenia patients. Moreover, this treatment was well tolerated. However, because our results might exhibit a small-study effect, future studies with a larger sample should be conducted to obtain more robust results.

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