Article type
Year
Abstract
Introduction/Objective: To determine the therapeutic efficacy of all the 114 interventions proposed for neuroleptic-induced tardive dyskinesia.
Methods: (1) Trials identification: electronic searches of Biological Abstracts, EMBASE, LILACS, MEDLINE, PsycLIT, SCISEARCH, and the CSG's Register; handsearches of the references of all identified studies; contact with the principal investigator of the included trials. (2) Quality criteria: reports were considered adequate if they were classified as A or B at the Cochrane Manual. The Jadad scale, with a cutoff of 2 points, was applied to check the validity of the above criteria. (3) Inclusion criteria: Every randomized, placebo-controlled trial, in which the intervention were proposed to reduce the symptoms of neuroleptic-induced tardive dyskinesia. (4) Statistical analysis: The data were extracted independently by two reviewers. Dichotomous data were evaluated by the OR and 95% confidence interval around this measurement; continuous data were evaluated by the average difference and 95% confidence interval. NNT and NNH were calculated using the inverse of the ARR. The reviewers assumed that patients who dropped out before the end of the study had no improvement.
Results: 62 clinical trials were included in at least one of the meta-analysis; 130 trials were allocated to an "awaiting assessment list", because of lack of reliable information; the others were excluded. Overall, only vitamin E, tiapride, oxypertine, L-dopa and insulin showed a potential benefit effect. Lithium and THIP were potentially harmful, and no effect could be detected in the other interventions. The NNT was 4 for vitamin E and oxypertine, 3 for L-dopa, 2 for insulin and tiapride; however, because of the wide confidence intervals these results are imprecise.
Discussion: (1) Implications for practice: None of the 114 interventions can be recommended as a treatment for tardive dyskinesia. If one of the interventions reviewed is used, the currently available evidence should be discussed with the patient and his or her relatives (2) Implications for research: Additional randomized controlled trials, evaluating the efficacy of vitamin E, oxypertine or tiapride to prevent or reduce the symptoms of tardive dyskinesia are required. Future trials should have adequate power to assess a reasonable clinical effect size, use a parallel group design, and extent over 24 weeks.
Methods: (1) Trials identification: electronic searches of Biological Abstracts, EMBASE, LILACS, MEDLINE, PsycLIT, SCISEARCH, and the CSG's Register; handsearches of the references of all identified studies; contact with the principal investigator of the included trials. (2) Quality criteria: reports were considered adequate if they were classified as A or B at the Cochrane Manual. The Jadad scale, with a cutoff of 2 points, was applied to check the validity of the above criteria. (3) Inclusion criteria: Every randomized, placebo-controlled trial, in which the intervention were proposed to reduce the symptoms of neuroleptic-induced tardive dyskinesia. (4) Statistical analysis: The data were extracted independently by two reviewers. Dichotomous data were evaluated by the OR and 95% confidence interval around this measurement; continuous data were evaluated by the average difference and 95% confidence interval. NNT and NNH were calculated using the inverse of the ARR. The reviewers assumed that patients who dropped out before the end of the study had no improvement.
Results: 62 clinical trials were included in at least one of the meta-analysis; 130 trials were allocated to an "awaiting assessment list", because of lack of reliable information; the others were excluded. Overall, only vitamin E, tiapride, oxypertine, L-dopa and insulin showed a potential benefit effect. Lithium and THIP were potentially harmful, and no effect could be detected in the other interventions. The NNT was 4 for vitamin E and oxypertine, 3 for L-dopa, 2 for insulin and tiapride; however, because of the wide confidence intervals these results are imprecise.
Discussion: (1) Implications for practice: None of the 114 interventions can be recommended as a treatment for tardive dyskinesia. If one of the interventions reviewed is used, the currently available evidence should be discussed with the patient and his or her relatives (2) Implications for research: Additional randomized controlled trials, evaluating the efficacy of vitamin E, oxypertine or tiapride to prevent or reduce the symptoms of tardive dyskinesia are required. Future trials should have adequate power to assess a reasonable clinical effect size, use a parallel group design, and extent over 24 weeks.