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Significant Differences ID'd Between Antimanic Drugs

Haloperidol, risperidone, and olanzapine most effective, but haloperidol has high drop-out rate

WEDNESDAY, Aug. 17 (HealthDay News) -- The various treatments for acute mania show statistically and clinically significant differences with haloperidol, risperidone, and olanzapine having better efficacy than other drugs, and olanzapine, risperidone, and quetiapine having lower dropout rates than haloperidol, which has the highest efficacy, according to a meta-analysis published online Aug. 17 in The Lancet.

Andrea Cipriani, Ph.D., from the University of Verona in Italy, and colleagues reviewed available literature from 1980 to 2010 to examine the direct and indirect effects of antimanic drugs. A multi-treatment meta-analysis was performed on 68 randomized controlled trials which compared any of the following pharmacological drugs at therapeutic dose range: aripiprazole, asenapine, carbamazepine, valproate, gabapentin, haloperidol, lamotrigine, lithium, olanzapine, quetiapine, risperidone, topiramate, and ziprasidone. Mean changes on mania rating scales, and the number of drop outs from the allocated treatment at three weeks were the main outcome measures.

The investigators found that haloperidol, risperidone, olanzapine, lithium, quetiapine, aripiprazole, carbamazepine, asenapine, valproate, and ziprasidone were more effective than placebo in treating mania, whereas gabapentin, lamotrigine, and topiramate were not. Haloperidol, which expressed the highest standardized mean difference, was found to be more effective than lithium, quetiapine, aripiprazole, carbamazepine, asenapine, valproate, ziprasidone, lamotrigine, topiramate, and gabapentin. Risperidone and olanzapine had a similar profile of comparative efficacy, both of which were more effective than valproate, ziprasidone, lamotrigine, topiramate, and gabapentin. Patients taking olanzapine, risperidone, and quetiapine had significantly fewer discontinuations compared to those taking lithium, lamotrigine, placebo, topiramate, and gabapentin.

"This study shows both statistically and clinically significant differences between treatments of acute mania. In terms of efficacy, haloperidol, risperidone, and olanzapine outperformed other drugs. In terms of drop-outs, olanzapine, risperidone, and quetiapine were better than haloperidol," the authors write.

Two of the study authors disclosed financial ties to the pharmaceutical industry.

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