Efficacy and safety of adjunctive topiramate for schizophrenia: a meta-analysis of randomized controlled trials

W. Zheng, Y.T. Xiang, Y.Q. Xiang, X.B. Li, Gabor Ungvari, H.F.K. Chiu, C.U. Correll

    Research output: Contribution to journalArticle

    31 Citations (Scopus)

    Abstract

    © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons LtdObjective: To systematically examine the randomized controlled trial (RCT) evidence regarding efficacy and tolerability of topiramate cotreatment with antipsychotics in schizophrenia-spectrum disorders. Methods: Random-effects meta-analysis of RCTs of topiramate cotreatment with antipsychotics vs. placebo/ongoing antipsychotic treatment in schizophrenia-spectrum disorders. Standardized or weighted mean difference (SMD/WMD), risk ratio (RR) ±95% confidence intervals (CIs), and number needed to harm (NNH) were calculated. Results: Across 16 RCTs (n = 934, duration = 11.8 ± 5.6 weeks), topiramate outperformed the comparator regarding change/endpoint of total (SMD: -0.58, 95% CI: -0.82, -0.35, P <0.00001), positive (SMD: -0.37, 95% CI: -0.61, -0.14, P = 0.002), negative (SMD: -0.58, 95% CI: -0.87, -0.29, P <0.0001), and general symptoms (SMD: -0.68, 95% CI: -0.95, -0.40, P <0.00001). Furthermore, topiramate was superior regarding body weight (WMD: –2.75 kg, 95% CI: -4.03, -1.47, P <0.0001), body mass index (BMI) (WMD: –1.77, 95% CI: -2.38, -1.15, P <0.00001), triglycerides (P = 0.006), and insulin levels (P <0.00001). Superiority regarding psychopathology and body weight/BMI was consistent across Chinese/Asian and Western RCTs, double-blind and open designs, clozapine and non-clozapine cotreatment, augmentation and co-initiation RCTs, and higher and lower quality RCTs. In meta-regression analyses, topiramate's efficacy for total symptoms was moderated by shorter illness duration (P = 0.047), while weight loss was greater in prevention/co-initiation vs. intervention/augmentation RCTs (-4.11 kg, 95% CI: -6.70, -1.52 vs. -1.41 kg, 95% CI: -2.23, -0.59, P <0.001). All-cause discontinuation was similar between topiramate and comparators (RR: 1.28, 95% CI: 0.91, 1.81, P = 0.16). While topiramate led to more concentration/attention difficulties (P = 0.03, NNH = 8, 95% CI=4–25), psychomotor slowing (P = 0.02, NNH = 7, 95% CI = 4–25), and paresthesia (P =
    Original languageEnglish
    Pages (from-to)385-398
    JournalActa Psychiatrica Scandinavica
    Volume134
    Issue number5
    DOIs
    Publication statusPublished - 2016

    Fingerprint Dive into the research topics of 'Efficacy and safety of adjunctive topiramate for schizophrenia: a meta-analysis of randomized controlled trials'. Together they form a unique fingerprint.

    Cite this