Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), imprecise results (few patients for each comparison) and indirectness (short follow-up time).
A Cochrane review [Abstract] 1 included 10 studies with a total of 675 subjects. The studies compared increasing the antipsychotic dose versus maintaining the original dose for people with schizophrenia who do not respond to their initial antipsychotic treatment. The run-in phase varied from 2 to 4 weeks, whereas the main phase varied from 2 to 12 weeks. No clear difference was found between groups regarding clinically relevant response (RR 1.09, 95% CI 0.86 to 1.40, 9 RCTs, n = 533), or left the study early due to adverse effects (RR 1.63, 95% CI 0.52 to 5.07; 7 trials, n=496), or due to any reason (RR 1.30, 95% CI 0.89 to 1.90, 5 RCTs, n = 353). Similarly, no clear difference was found in general mental state as measured by PANSS total score change (MD −1.44, 95% CI −6.85 to 3.97, 3 RCTs, n = 258). At least one adverse effect was equivocal between groups (RR 0.91, 95% CI 0.55 to 1.50, 2 RCTs, n = 191).
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