TY - JOUR
T1 - Mood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase
T2 - a systematic review and network meta-analysis of randomized controlled trials
AU - Kishi, Taro
AU - Ikuta, Toshikazu
AU - Matsuda, Yuki
AU - Sakuma, Kenji
AU - Okuya, Makoto
AU - Mishima, Kazuo
AU - Iwata, Nakao
N1 - Funding Information:
Funding The present study was supported by the Health and Labor Sciences Research Grants (H29-Seishin-Ippan-001, 19GC1012).
Funding Information:
Conflict of interest The authors have declared that there are no conflicts of interest relating to the subject of this study. Interests from the past three years are as follows. Dr. Kishi received speaker’s honoraria from Daiichi Sankyo, Dainippon Sumitomo, Eisai, Janssen, Otsuka, Meiji, Mochida, MSD, and Tanabe-Mitsubishi (Yoshitomi); as well as research grants from the Japanese Ministry of Health, Labor and Welfare (H29-Seishin-Ippan-001, 19GC1012), Grant-in-Aid for Scientific Research (C), and Fujita Health University School of Medicine. Dr. Ikuta has no conflicts of interest with any company. Dr. Matsuda has received speaker’s honoraria from Dainippon Sumitomo, Janssen, Kyowa, Otsuka, Tanabe-Mitsubishi, and Yoshitomi. Dr. Sakuma has received speaker’s honoraria from Eisai, Kissei, Meiji, Otsuka, and Torii; and has received a Fujita Health University School of Medicine research grant, as well as a Grant-in-Aid for Young Scientists (B). Dr. Okuya has received speaker’s honoraria from Meiji. Dr. Mishima received research support from the Japanese Ministry of Health, Labor and Welfare (H29-Seishin-Ippan-001, 19GC1012) and the Japanese Ministry of Education, Culture, Sports, Science and Technology Collaborative research fund with Taisho; as well as speaker’s honoraria from Eisai, MSD, Takeda, Astellas, Pfizer, Otsuka, Mochida, Mitsubishi Tanabe, Yoshitomi, and Janssen; and research grants from Eisai, Nobelpharma, Otsuka, and Takeda. Dr. Iwata received speaker’s honoraria from Dainippon Sumitomo, Eli Lilly, GlaxoSmithKline, Janssen, Yoshitomi, Otsuka, Takeda, Meiji, and Pfizer; along with research grants from Daiichi Sankyo, Takeda, Dainippon Sumitomo Eisai, Meiji Tanabe-Mitsubishi and Otsuka.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020
Y1 - 2020
N2 - We searched Embase, PubMed, and CENTRAL from inception until 22 May 2020 to investigate which antipsychotics and/or mood stabilizers are better for patients with bipolar disorder in the maintenance phase. We performed two categorical network meta-analyses. The first included monotherapy studies and studies in which the two drugs used were specified (i.e., aripiprazole, aripiprazole once monthly, aripiprazole+lamotrigine, aripiprazole+valproate, asenapine, carbamazepine, lamotrigine, lamotrigine+valproate, lithium, lithium+oxcarbazepine, lithium+valproate, olanzapine, paliperidone, quetiapine, risperidone long-acting injection, valproate, and placebo). The second included studies on second-generation antipsychotic combination therapies (SGAs) (i.e., aripiprazole, lurasidone, olanzapine, quetiapine, and ziprasidone) with lithium or valproate (LIT/VAL) compared with placebo with LIT/VAL. Outcomes were recurrence/relapse rate of any mood episode (RR-any, primary), depressive episode (RR-dep) and manic/hypomanic/mixed episode (RR-mania), discontinuation, mortality, and individual adverse events. Risk ratios and 95% credible interval were calculated. Forty-one randomized controlled trials were identified (n = 9821; mean study duration, 70.5 ± 36.6 weeks; percent female, 54.1%; mean age, 40.7 years). All active treatments other than carbamazepine, lamotrigine+valproate (no data) and paliperidone outperformed the placebo for RR-any. Aripiprazole+valproate, lamotrigine, lamotrigine+valproate, lithium, olanzapine, and quetiapine outperformed placebo for RR-dep. All active treatments, other than aripiprazole+valproate, carbamazepine, lamotrigine, and lamotrigine+valproate, outperformed placebo for RR-mania. Asenapine, lithium, olanzapine, quetiapine, and valproate outperformed placebo for all-cause discontinuation. All SGAs+LIT/VALs other than olanzapine+LIT/VAL outperformed placebo+LIT/VAL for RR-any. Lurasidone+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for RR-dep. Aripiprazole+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for RR-mania. Lurasidone+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for all-cause discontinuation. Treatment efficacy, tolerability, and safety profiles differed among treatments.
AB - We searched Embase, PubMed, and CENTRAL from inception until 22 May 2020 to investigate which antipsychotics and/or mood stabilizers are better for patients with bipolar disorder in the maintenance phase. We performed two categorical network meta-analyses. The first included monotherapy studies and studies in which the two drugs used were specified (i.e., aripiprazole, aripiprazole once monthly, aripiprazole+lamotrigine, aripiprazole+valproate, asenapine, carbamazepine, lamotrigine, lamotrigine+valproate, lithium, lithium+oxcarbazepine, lithium+valproate, olanzapine, paliperidone, quetiapine, risperidone long-acting injection, valproate, and placebo). The second included studies on second-generation antipsychotic combination therapies (SGAs) (i.e., aripiprazole, lurasidone, olanzapine, quetiapine, and ziprasidone) with lithium or valproate (LIT/VAL) compared with placebo with LIT/VAL. Outcomes were recurrence/relapse rate of any mood episode (RR-any, primary), depressive episode (RR-dep) and manic/hypomanic/mixed episode (RR-mania), discontinuation, mortality, and individual adverse events. Risk ratios and 95% credible interval were calculated. Forty-one randomized controlled trials were identified (n = 9821; mean study duration, 70.5 ± 36.6 weeks; percent female, 54.1%; mean age, 40.7 years). All active treatments other than carbamazepine, lamotrigine+valproate (no data) and paliperidone outperformed the placebo for RR-any. Aripiprazole+valproate, lamotrigine, lamotrigine+valproate, lithium, olanzapine, and quetiapine outperformed placebo for RR-dep. All active treatments, other than aripiprazole+valproate, carbamazepine, lamotrigine, and lamotrigine+valproate, outperformed placebo for RR-mania. Asenapine, lithium, olanzapine, quetiapine, and valproate outperformed placebo for all-cause discontinuation. All SGAs+LIT/VALs other than olanzapine+LIT/VAL outperformed placebo+LIT/VAL for RR-any. Lurasidone+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for RR-dep. Aripiprazole+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for RR-mania. Lurasidone+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for all-cause discontinuation. Treatment efficacy, tolerability, and safety profiles differed among treatments.
UR - http://www.scopus.com/inward/record.url?scp=85095828154&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85095828154&partnerID=8YFLogxK
U2 - 10.1038/s41380-020-00946-6
DO - 10.1038/s41380-020-00946-6
M3 - Article
AN - SCOPUS:85095828154
JO - Molecular Psychiatry
JF - Molecular Psychiatry
SN - 1359-4184
ER -