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Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials.
J Clin Psychopharmacol. 2020 Mar/Apr; 40(2):167-179.JC

Abstract

PURPOSE/BACKGROUND

The aim of the study was to estimate and rank the risk for the discontinuation due to adverse events (DAEs), 7% or more weight gain (WG), and somnolence during the acute and maintenance treatment of bipolar disorder with a mood stabilizer or an antipsychotic monotherapy.

METHODS/PROCEDURES

The search of MEDLINE, EMBASE, PsycINFO, and clinicaltrials.gov from the inception to December 31, 2018, provided 32 studies in mania, 16 in bipolar depression, and 13 in maintenance. Data of DAEs, WG, and somnolence from each study were extracted. The risk for these variables of an active treatment relative to placebo was estimated with a number needed to harm (NNH) as a single study and pooled sample.

FINDINGS/RESULTS

For DAEs, pooled NNH ranged from 19 with carbamazepine to -21 with quetiapine-XR in mania, 11 with quetiapine-IR 600 mg/d to -37 with olanzapine/fluoxetine combination in bipolar depression, and 5 with lithium to -8 with asenapine in maintenance. For WG, pooled NNH ranged from 9 with olanzapine to -78 with aripiprazole in mania, 5 with olanzapine to -112 with lithium in bipolar depression, and 4 with olanzapine to 126 with asenapine in maintenance. For somnolence, pooled NNH was from 5 with carbamazepine to 23 with cariprazine in mania, 3 with quetiapine-XR 300 mg/d to 79 with lurasidone in bipolar depression, and 11 with olanzapine to -49 with aripiprazole in maintenance.

IMPLICATIONS/CONCLUSIONS

All medications studied in bipolar disorder were relatively well tolerated during different phases of treatment; however, the risk for short- and long-term WG and somnolence varied widely among included psychotropics.

Authors+Show Affiliations

From the Shenzhen Kangning Hospital, Shenzhen, Guangdong, China. Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, University Hospitals Cleveland Medical Center.From the Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.From the Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry, University Hospitals Cleveland Medical Center. Case Western Reserve University School of Medicine, Cleveland, OH.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32134852

Citation

Bai, Yuanhan, et al. "Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: a Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials." Journal of Clinical Psychopharmacology, vol. 40, no. 2, 2020, pp. 167-179.
Bai Y, Yang H, Chen G, et al. Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials. J Clin Psychopharmacol. 2020;40(2):167-179.
Bai, Y., Yang, H., Chen, G., & Gao, K. (2020). Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials. Journal of Clinical Psychopharmacology, 40(2), 167-179. https://doi.org/10.1097/JCP.0000000000001169
Bai Y, et al. Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: a Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials. J Clin Psychopharmacol. 2020 Mar/Apr;40(2):167-179. PubMed PMID: 32134852.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials. AU - Bai,Yuanhan, AU - Yang,Haichen, AU - Chen,Guanjie, AU - Gao,Keming, PY - 2020/3/6/entrez SP - 167 EP - 179 JF - Journal of clinical psychopharmacology JO - J Clin Psychopharmacol VL - 40 IS - 2 N2 - PURPOSE/BACKGROUND: The aim of the study was to estimate and rank the risk for the discontinuation due to adverse events (DAEs), 7% or more weight gain (WG), and somnolence during the acute and maintenance treatment of bipolar disorder with a mood stabilizer or an antipsychotic monotherapy. METHODS/PROCEDURES: The search of MEDLINE, EMBASE, PsycINFO, and clinicaltrials.gov from the inception to December 31, 2018, provided 32 studies in mania, 16 in bipolar depression, and 13 in maintenance. Data of DAEs, WG, and somnolence from each study were extracted. The risk for these variables of an active treatment relative to placebo was estimated with a number needed to harm (NNH) as a single study and pooled sample. FINDINGS/RESULTS: For DAEs, pooled NNH ranged from 19 with carbamazepine to -21 with quetiapine-XR in mania, 11 with quetiapine-IR 600 mg/d to -37 with olanzapine/fluoxetine combination in bipolar depression, and 5 with lithium to -8 with asenapine in maintenance. For WG, pooled NNH ranged from 9 with olanzapine to -78 with aripiprazole in mania, 5 with olanzapine to -112 with lithium in bipolar depression, and 4 with olanzapine to 126 with asenapine in maintenance. For somnolence, pooled NNH was from 5 with carbamazepine to 23 with cariprazine in mania, 3 with quetiapine-XR 300 mg/d to 79 with lurasidone in bipolar depression, and 11 with olanzapine to -49 with aripiprazole in maintenance. IMPLICATIONS/CONCLUSIONS: All medications studied in bipolar disorder were relatively well tolerated during different phases of treatment; however, the risk for short- and long-term WG and somnolence varied widely among included psychotropics. SN - 1533-712X UR - https://www.unboundmedicine.com/medline/citation/32134852/Acceptability_of_Acute_and_Maintenance_Pharmacotherapy_of_Bipolar_Disorder:_A_Systematic_Review_of_Randomized,_Double-Blind,_Placebo-Controlled_Clinical_Trials L2 - https://doi.org/10.1097/JCP.0000000000001169 DB - PRIME DP - Unbound Medicine ER -
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