© 2003 The Royal College of Psychiatrists
Clozapine v. conventional antipsychotic drugs for treatment-resistant schizophrenia: a re-examination
Department of Psychiatry and Behavioural Science, University College London, and Honorary Consultant Psychiatrist, North East London Mental Health NHS Trust, Warley Hospital, Mascalls Park, Brentwood, Essex CM14 5HQ, UK
Background Although there is a consensus that clozapine is more effective than conventional antipsychotic drugs for treatment-resistant schizophrenia, there is great heterogeneity among results of relevant trials.
Aims To re-evaluate the evidence comparing clozapine with conventional antipsychotics and to investigate sources of heterogeneity.
Method Individual studies were inspected with assessment of clinical relevance of results. Meta-regression analysis was performed to investigate sources of heterogeneity.
Results Ten trials were examined. Recent large-scale studies have not found a substantial advantage for clozapine, especially in terms of a clinically relevant effect. Meta-regression showed that shorter study duration, financial support from a drug company and higher baseline symptom score consistently predicted greater advantage of clozapine.
Conclusions It may be inappropriate to combine studies in meta-analysis, given the degree of heterogeneity between their findings. The benefits of clozapine compared with conventional treatment may not be substantial.
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