Zuclopenthixol Dihydrochloride for Schizophrenia
Oral zuclopenthixol might possibly not differ from other antipsychotics in the treatment of schizophrenia, but the evidence is insufficient. Level of evidence: "D"A Cochrane review [Abstract] 1 included 20 studies with a total of 1850 subjects with schizophrenia. Data were reported for 12 comparisons, predominantly for the short term (up to 12 weeks) and inpatient populations.
Zuclopenthixol versus:
- Placebo:Movement disorders (EPSEs) were similar between groups (RR 6.07 95% CI 0.86 to 43.04; 1 RCT, n = 28). There was no clear difference in numbers leaving the study early (RR 0.29, 95% CI 0.01 to 6.60; 2 RCTs, n = 100).
- Chlorpromazine: No clear differences were found for the outcomes of global state (average CGI-SI endpoint score) (MD 0.00, 95% CI -0.49 to 0.49; 1 RCT, n = 60) or movement disorders (EPSEs) (RR 0.94, 95% CI 0.61 to 1.45; 3 RCTs, n = 199). More people left the study early for any reason from the zuclopenthixol group (RR 0.54, 95% CI 0.36 to 0.81; 6 RCTs, n = 766).
- Chlorprothixene:There was no clear difference in numbers leaving the study early for any reason (RR 1.00, 95% CI 0.34 to 2.93; 1 RCT, n = 20).
- Clozapine:No useable data were presented.
- Haloperidol: No clear differences between treatment groups were found for the outcomes global state score (average CGI endpoint score in this and all other comparisons) (MD 0.13, 95% CI -0.30 to 0.55; 1 RCT, n = 49) or leaving the study early (RR 0.99, 95% CI 0.72 to 1.35; 2 RCTs, n = 141).
- Perphenazine:Those receiving zuclopenthixol were more likely to require medication in the short term for EPSEs than perphenazine (RR 1.90, 95% CI 1.12 to 3.22; 1 RCT, n = 50). Similar numbers left the study early (RR 0.63, 95% CI 0.27 to 1.47; 2 RCTs, n = 104).
- Risperidone:Those receiving zuclopenthixol were more likely to require medications for EPSEs than risperidone (RR 1.92, 95% CI 1.12 to 3.28; 1 RCT, n = 98). There was no clear difference in numbers leaving the study early (RR 1.30, 95% CI 0.84 to 2.02; 3 RCTs, n = 154) or in mental state (average PANSS total endpoint score) (MD -3.20, 95% CI -7.71 to 1.31; 1 RCT, n = 25).
- Sulpiride:No clear differences were found for global state (RR 1.18, 95% CI 0.49 to 2.85; 1 RCT, n = 61), requiring hypnotics/sedatives (RR 0.60, 95% CI 0.27 to 1.32; 1 RCT, n = 61) or leaving the study early (RR 2.07 95% CI 0.97 to 4.40; 1 RCT, n = 61).
- Thiothixene:No clear differences were found for the outcomes of global state (RR 0.50, 95% CI 0.17 to 1.46; 1 RCT, n = 20) or leaving the study early (RR 0.57, 95% CI 0.24 to 1.35; 1 RCT, n = 20).
- Trifluoperazine:No useable data were presented.
- Zuclopenthixol depot:There was no clear difference in numbers leaving the study early (RR 1.95, 95% CI 0.36 to 10.58; 1 RCT, n = 46).
- Zuclopenthixol dihydrochloride (cis z isomer) versus zuclopenthixol (cis z/trans e isomer):There were no clear differences in reported side-effects ( RR 1.34, 95% CI 0.82 to 2.18; 1 RCT, n = 57) and in numbers leaving the study early (RR 2.15, 95% CI 0.49 to 9.41; 4 RCTs, n = 140).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), imprecise results (limited study size for each comparison) and indirectness (short follow-up time).
References
- Bryan EJ, Purcell MA, Kumar A. Zuclopenthixol dihydrochloride for schizophrenia. Cochrane Database Syst Rev 2017;11():CD005474. [PubMed]