Predictors of response to pharmacological treatments in treatment-resistant schizophrenia - A systematic review and meta-analysis
Seppälä, Annika (Oulu University Hospital (Finlàndia))
Pylvänäinen, Jenni (Oulu University Hospital (Finlàndia))
Lehtiniemi, Heli (University of Oulu (Finlàndia))
Hirvonen, Noora (University of Oulu (Finlàndia))
Corripio, Iluminada (Institut d'Investigació Biomèdica Sant Pau)
Koponen, Hannu (University of Helsinki and Helsinki University Hospital. Psychiatry)
Seppälä, Jussi (Department of Mental Health and Substance Use Disorders. South Carelia Social and Health Care District)
Ahmed, Anthony (Cornell University. Department of Psychiatry)
Isohanni, Matti (Oulu University Hospital (Finlàndia))
Miettunen, Jouko (Oulu University Hospital (Finlàndia))
Jaaskelainen, Erika (Oulu University Hospital (Finlàndia))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Background: As the burden of treatment-resistant schizophrenia (TRS) on patients and society is high it is important to identify predictors of response to medications in TRS. The aim was to analyse whether baseline patient and study characteristics predict treatment response in TRS in drug trials. Methods: A comprehensive search strategy completed in PubMed, Cochrane and Web of Science helped identify relevant studies. The studies had to meet the following criteria: English language clinical trial of pharmacological treatment of TRS, clear definition of TRS and response, percentage of response reported, at least one baseline characteristic presented, and total sample size of at least 15. Meta-regression techniques served to explore whether baseline characteristics predict response to medication in TRS. Results: 77 articles were included in the systematic review. The overall sample included 7546 patients, of which 41% achieved response. Higher positive symptom score at baseline predicted higher response percentage. None of the other baseline patient or study characteristics achieved statistical significance at predicting response. When analysed in groups divided by antipsychotic drugs, studies of clozapine and other atypical antipsychotics produced the highest response rate. Conclusions: This meta-analytic review identified surprisingly few baseline characteristics that predicted treatment response. However, higher positive symptoms and the use of atypical antipsychotics - particularly clozapine -was associated with the greatest likelihood of response. The difficulty involved in the prediction of medication response in TRS necessitates careful monitoring and personalised medication management. There is a need for more investigations of the predictors of treatment response in TRS.
Nota:	Altres ajuts: the Finnish Cultural Foundation (Grant number 2DC49079); Jalmari and Rauha Ahokas' Foundation; the Academy of Finland (Grant number 316563); Oulu University Hospital funding.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	Schizophrenia ; Treatment-resistant meta-analysis ; Predictors ; Response ; Pharmacological treatment
Publicat a:	Schizophrenia Research, Vol. 236 (october 2021) , p. 123-134, ISSN 1573-2509

DOI: 10.1016/j.schres.2021.08.005
PMID: 34496316

12 p, 2.2 MB

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