Schizophrenia Bulletin Advance Access published online on November 27, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp149
Low Dose vs Standard Dose of Antipsychotics for Relapse Prevention in Schizophrenia: Meta-analysis
2 Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
3 Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
4 Multimodal Imaging Group, PET Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
5 Department of Psychiatry, University of Toronto, Ontario, Canada
6 Biostatistical Consulting Service, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
1 To whom correspondence should be addressed; tel: +81 3 5363 3829, fax: +81 3 5379 0187, e-mail: mcn41320{at}biglobe.ne.jp.
Background: It remains unknown as to whether the antipsychotic dose needed for the acute-phase treatment of schizophrenia is also necessary for relapse prevention. Aim: To compare the efficacy between standard dose [(World Health Organization daily defined dose (DDD)] vs low dose (
50% to <1 DDD) or very low dose (<50% DDD) for relapse prevention in schizophrenia. Data source: Double-blind, randomized, controlled trials with a follow-up duration of 24 weeks, including 2 dosage groups of the same antipsychotic drug for relapse prevention in schizophrenia, were searched using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE (last search: August 2009). Data extraction: Data on overall treatment failure, hospitalization, relapse, and dropouts due to side effects were extracted and combined in a meta-analysis. Data synthesis: Thirteen studies with 1395 subjects were included in this meta-analysis. Compared with the standard-dose treatment, the low-dose therapy did not show any statistically significant difference in overall treatment failure or hospitalization, while the standard dose showed a trend-level (P = .05) superiority in risk of relapse. The very low–dose group was inferior to the standard-dose group in all efficacy parameters. No significant difference was found in the rate of dropouts due to side effects between either standard dose vs low dose or very low dose. Conclusions: Although antipsychotic treatment with 50% to <1 DDD may be as effective as standard-dose therapy, there are insufficient clinical trial data to draw firm conclusions on standard- vs low-dose maintenance antipsychotic therapy for schizophrenia.
Keywords: antipsychotic / dose / neuroleptic / relapse prevention / schizophrenia