A Systematic Review of Current Evidence and Gaps on the Impact of Oral Antipsychotic Treatments in Schizophrenia
Author(s)
Adhikari K1, Kamal K1, Jeun KJ2, Nolfi D3, Zacker C4
1West Virginia University, Morgantown, WV, USA, 2University of West Virginia, Morgantown, WV, USA, 3Duquesne University, Pittsburgh, PA, USA, 4Cerevel Therapeutics, Cambridge, MA, USA
OBJECTIVES: Schizophrenia, a complex disease with no current cure, affects about 1% of the US population. The burden of schizophrenia is significantly impacted due to heterogeneity observed across medications’ adherence, efficacy, safety, economic, and effectiveness outcomes. The study goal is to provide an in-depth review of studies that describe the clinical, economic, and humanistic outcomes associated with oral medications in schizophrenia.
METHODS: A systematic literature search was conducted according to PRISMA-S guidelines using three databases (PsycINFO, PubMed, and CINAHL) to identify relevant articles from January 2010 to March 2022. Controlled search included studies reporting data about medication adherence, safety, economic, treatment efficacy, humanistic, behavioral, and product switching outcomes. Non-English studies, non-human studies, case reports and review articles were excluded from the review.
RESULTS:
A total of 24,190 articles were identified and based on the inclusion/exclusion criteria from different databases and Health Technology Assessment (HTA) websites, 133 studies were included in the final review. The studies included treatment efficacy (n=104), adverse events (n=73), economic outcomes (n=36), humanistic outcomes (n=9), product switching (n=9), medication adherence (n=11) and behavioral outcomes (n=1). Majority of studies showed that antipsychotic medications had better efficacy than placebo, suggesting their value in schizophrenia management. Among adverse events, most studies reported weight gain, nausea, sedation, and anxiety in patients. Economic outcomes included cost effectiveness analyses identifying medication non-adherence and treatment discontinuation as predominant factors to the economic burden of schizophrenia. The HTAs included the same outcomes with treatment efficacy. Product switching studies measured psychosocial function changes after switching.CONCLUSIONS: The systematic review reveals limited studies addressing the humanistic and behavioral outcomes in schizophrenia. There remains a significant knowledge gap suggesting the need for evidence generation to help decision makers effectively manage the disease and customized treatment opportunities for patients with schizophrenia.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
MSR93
Topic
Study Approaches
Topic Subcategory
Literature Review & Synthesis
Disease
Mental Health (including addition)