The treatment of tardive dyskinesia - a systematic review and meta-analysis

McGrath, J. J. (1999) The treatment of tardive dyskinesia - a systematic review and meta-analysis. Schizophrenia Research, 39 1: 1-16. doi:10.1016/S0920-9964(99)00021-3


Author McGrath, J. J.
Title The treatment of tardive dyskinesia - a systematic review and meta-analysis
Journal name Schizophrenia Research   Check publisher's open access policy
ISSN 0902-9964
Publication date 1999-01-01
Year available 1999
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/S0920-9964(99)00021-3
Open Access Status
Volume 39
Issue 1
Start page 1
End page 16
Total pages 16
Editor H. Nasrallah
L. DeLisi
Place of publication New York
Publisher Elsevier
Language eng
Subject C3
321021 Psychiatry
730211 Mental health
Abstract This systematic review aimed to collate randomized controlled trials (RCTs) of various interventions used to treat tardive dyskinesia (TD) and, where appropriate, to combine the data for mete-analysis, Clinical trials were identified by electronic searches, handsearches and contact with principal investigators. Data were extracted independently by two reviewers, for outcomes related to improvement, deterioration, side-effects and drop out rates. Data were pooled using the Mantel-Haenzel Odds Ratio (fixed effect model). For treatments that had significant effects, the number needed to treat (NNT) was calculated. From 296 controlled clinical trials, data were extracted from 47 trials. For most interventions, we could identify no RCT-derived evidence of efficacy. A meta-analysis showed that baclofen, deanol and diazepam were no more effective than a placebo. Single RCTs demonstrated a lack of evidence of any effect for bromocriptine, ceruletide, clonidine, estrogen, gamma linolenic acid, hydergine, lecithin, lithium, progabide, seligiline and tetrahydroisoxazolopyridinol. The meta-analysis found that five interventions were effective: L-dopa, oxypertine, sodium valproate, tiapride and vitamin E; neuroleptic reduction was marginally significant. Data from single RCTs revealed that insulin, alpha methyl dopa and reserpine were more effective than a placebo. There was a significantly increased risk of adverse events associated with baclofen, deanol, L-dopa, oxypertine and reserpine. Metaanalysis of the impact of placebo (n=485) showed that 37.3% of participants showed an improvement. Interpretation of this systematic review requires caution as the individual trials identified tended to have small sample sizes. For many compounds, data from only one trial were available, and where meta-analyses were possible, these were based on a small number of trials. Despite these concerns, the review facilitated the interpretation of the large and diverse range of treatments used for TD. Clinical recommendations for the treatment of TD are made, based on the availability of RCT-derived evidence, the strength of that evidence and the presence of adverse effects. (C) 1999 Elsevier Science B.V. All rights reserved.
Keyword Randomized Clinical-Trials
Vitamin-E
Sodium Valproate
Quality
Metaanalysis
Bias
Schizophrenia
Baclofen
Q-Index Code C3
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: Queensland Brain Institute Publications
 
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