Selective Noradrenaline Reuptake Inhibitors for Schizophrenia

Summary

A Cochrane review [Abstract] 1 included 16 studies with a total of 919 subjects. The majority of trials included inpatients with schizophrenia or similar illness and most trials included patients with a chronic presentation. The selective noradrenaline reuptake inhibitor (NRI) was reboxetine in 9 trials, atomoxetine and viloxazine were used in other trials. Placebo was a comparator in 14 trials. Most trials were of short duration: 11 lasted from 2 to 12 weeks and 5 lasted from 13 to 26 weeks. Mental state results showed significantly greater rates of improvement in negative symptoms scores (RR 3.17, 95% CI 1.52 to 6.58; 1 RCT, n = 50) with NRIs on the Positive and Negative Syndrome Scale (PANSS) negative. No data were reported for significant response or improvement in positive symptoms, but average endpoint PANSS positive scores were available and showed no difference between NRIs and placebo (MD −0.16, 95% CI −0.96 to 0.63; 5 RCTs, n = 294). Improvement in clinical global status was similar between groups (RR 0.99, 95% CI 0.45 to 2.20; 1 RCT, n = 28). Significant response or improvement in cognitive functioning data were not reported. Average composite cognitive scores showed no difference between NRIs and placebo (SMD 0.04, 95% CI −0.28 to 0.36; 4 RCTs, n = 180). Significant response or improvement in quality of life data were not reported, however average endpoint scores from the GQOLI-74 were reported. Those receiving NRIs had better quality of life scores compared to placebo (MD 9.36, 95% CI 7.89 to 10.83; 1 RCT, n = 114). All-cause withdrawals did not differ between the treatment groups (RR 0.94 95% CI 0.63 to 1.39; 8 RCTs, n = 401). Rates of nausea were not greater with NRIs (RR 0.49, 95% CI 0.10 to 2.41; 3 RCTs, n = 176).