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November 6, 2019

Ranking Antipsychotics for Efficacy and Safety in Schizophrenia

Author Affiliations
  • 1Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
  • 2Department of Psychiatry and Molecular Medicine, Donald and Barbara School of Medicine at Hofstra/Northwell, Hempstead, New York
  • 3The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York
  • 4Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
JAMA Psychiatry. Published online November 6, 2019. doi:https://doi.org/10.1001/jamapsychiatry.2019.3377

Given the numerous randomized clinical trials (RCTs) of antidopaminergic agents for schizophrenia, meta-analyses can help compare their efficacy and safety/tolerability. Because many medications have never been directly compared, network meta-analyses (NMAs) using direct and indirect effect size estimates via common comparators have been introduced. Because “transitivity” (eg, similar populations, treatment, and measurement approaches) is required, changes in patient, illness, treatment, trial design/conduct characteristics, and increasing placebo effects in schizophrenia trials1 challenge the underlying assumptions of NMAs.

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