Treatments for Schizophrenia in Adults: A Systematic Review

Comparative Effectiveness Review Number 198

Treatments for Schizophrenia in Adults: A Systematic Review

e

Comparative Effectiveness Review

Number 198

Treatments for Schizophrenia in Adults: A Systematic Review

Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857

Contract No. 290-2015-00009-I

Prepared by: Pacific Northwest Evidence-based Practice Center Portland, OR

Investigators: Marian S. McDonagh, Pharm.D. Tracy Dana, M.L.S. Shelley Selph, M.D., M.P.H. Emily B. Devine, Pharm.D., Ph.D., M.B.A. Amy Cantor, M.D., M.P.H. Christina Bougatsos, M.P.H. Ian Blazina, M.P.H. Sara Grusing, B.A. Rochelle Fu, Ph.D. Sarah L. Kopelovich, Ph.D. Maria Monroe-DeVita, Ph.D. Daniel W. Haupt, M.D.

AHRQ Publication No. 17(18)-EHC031-EF October 2017

Key Messages

Purpose of Review To evaluate treatments for schizophrenia. Key Messages ? Olanzapine, aripiprazole, risperidone, quetiapine, and ziprasidone were similar in

function, quality of life, mortality, and overall adverse events. Core illness symptoms were better with olanzapine and risperidone than asenapine, quetiapine, and ziprasidone, and with paliperidone than lurasidone and iloperidone. ? Haloperidol had similar benefits but more adverse events than olanzapine and risperidone. ? Psychosocial treatments improved outcomes versus usual care: assertive community care (core illness symptoms, function), cognitive behavioral therapy (core illness symptoms, function, quality of life), cognitive remediation (core illness symptoms), family interventions (core illness symptoms, function, relapse), illness self-management (core illness symptoms), psychoeducation (core illness symptoms, function, relapse), social skills training (core illness symptoms, function), and supported employment (core illness symptoms, employment).

ii

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help health care decisionmakers--patients and clinicians, health system leaders, and policymakers, among others--make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at effectivehealthcare.. Search on the title of the report.

Persons using assistive technology may not be able to fully access information in this report. For assistance contact epc@ahrq..

Suggested citation: McDonagh MS, Dana T, Selph S, Devine EB, Cantor A, Bougatsos C, Blazina I, Grusing S, Fu R, Kopelovich SL, Monroe-DeVita M, Haupt DW. Treatments for Schizophrenia in Adults: A Systematic Review. Comparative Effectiveness Review No. 198. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 2902015-00009-I.) AHRQ Publication No. 17(18)-EHC031-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2017. effectivehealthcare.reports/final.cfm. DOI: .

iii

Preface

The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies.

Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see effectivehealthcare.reference/purpose.cfm.

AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (effectivehealthcare.) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input.

If you have comments on this evidence report, they may be sent by mail to the Task Order Officers named below at: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, or by email to epc@ahrq..

Gopal Khanna, M.B.A. Director Agency for Healthcare Research and Quality

Stephanie Chang, M.D., M.P.H. Director Evidence-based Practice Center Program Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality

Arlene S. Bierman, M.D., M.S. Director Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality

David W. Niebuhr, M.D., M.P.H., M.Sc. Aysegul Gozu, M.D., M.P.H. Task Order Officers Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality

iv

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download