Dopamine partial agonists and prodopaminergic drugs for schizophrenia: Systematic review and meta-analysis of randomized controlled trials

Dopamine partial agonists and prodopaminergic drugs for schizophrenia: Systematic review and meta-analysis of randomized controlled trials

Authors
Osugo, M. Whitehurst, T. Shatalina, E. Townsend, L. O'Brien, O. Mak, T. L. A. McCutcheon, R. Howes, O.
Year
2022
Journal
Neuroscience and Biobehavioral Reviews Vol 135 2022, ArtID 104568
Volume
135
Pages
Dopaminergic dysfunction is thought to be central to schizophrenia symptomatology. Previous meta-analyses of prodopaminergic drugs in schizophrenia have important limitations, and also did not include dopamine D2/D3 partial agonists. We investigated the effect of medications which increase dopamine signalling on schizophrenia symptoms by meta-analysing double-blind, placebo-controlled RCTs. 59 RCTs were included: 29 of prodopaminergic treatments, 30 of partial agonists. Partial agonists were significantly superior to placebo against positive (SMD=-0.33,p = 1.2 x10-17), negative (SMD=-0.29,p = 2.2 x 10-31) and total symptoms (SMD =-0.39,p = 1.7 x 10-30) in schizophrenia. There were no significant differences between pooled pro-dopaminergic drugs and placebo in any symptom domain. In subgroup analysis of five studies where patients were selected for negative symptom severity, ar/modafinil was superior to placebo against negative symptoms (SMD=-0.34,p = 0.037). These data favour the clinical use of partial agonists for negative symptoms in schizophrenia, with clinically meaningful effect sizes. Our findings also suggest a benefit for ar/modafinil in patients with predominant negative symptoms. Future trials of other prodopaminergic therapies and dopamine partial agonists in patients with predominant negative symptoms are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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Type of intervention

Treatment and Child Welfare Interventions

Topic

Mental Health Problems and Disorders

Other Problems

Psychosis

Intervention

Pharmacological Treatment

Antipsychotics

Age group

Adolescents (13-18 years)

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