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A Systematic Review of Combination and High-Dose Atypical Antipsychotic Therapy in Patients with Schizophrenia [Internet]

A Systematic Review of Combination and High-Dose Atypical Antipsychotic Therapy in Patients with Schizophrenia [Internet]

CADTH Optimal Use Report - Canadian Agency for Drugs and Technologies in Health

Version: December 2011

OBJECTIVES

The objective of this study was to identify and appraise the clinical evidence pertaining to use of AAP combination therapy and high-dose treatment strategies in adolescents and adults with schizophrenia.

ISSUE

Large deviations from optimal utilization (overuse or underuse) Size of patient populations Impact on health outcomes and cost-effectiveness Benefit to multiple jurisdictions Measurable outcomes Potential to effect change in prescribing and use.

RESULTS

Figure 1 illustrates the selection process used to identify primary studies comparing AAP combination therapy with APD monotherapy as well as high-dose AAP therapy with standard-dose APD therapy in patients inadequately controlled on APD monotherapy. After removal of duplicates, a total of 2,824 citations were identified in the literature search. Of these, 2,599 citations were excluded, based on titles and/or abstracts. These consisted mainly of reviews, study designs other than RCTs, and studies in which comparators were not of interest. Full-text articles of the remaining 225 citations were assessed, and 41 articles representing 30 unique RCTs were included in the systematic review. The complete lists of included and excluded studies are presented in Appendices 6 and , respectively. In several instances, data from the same clinical trial were presented in multiple articles; these are outlined in Appendix 8. The publication with the longest duration of follow-up was used when analyzing data from such trials. Data from 19 articles describing 18 RCTs were included in the meta-analyses. A summary of studies not included in the reference cases is presented in Appendix 18.

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