The efficacy of zotepine in schizophrenia: A meta-analysis of BPRS and improvement scale scores

OBJECT: To assess the efficacy of the antipsychotic drug zotepine in the tr eatment of the global psychopathology of schizophrenia. METHOD: Fifteen randomized placebo- or antipsychotic comparator-controlled trials were analysed, using the Brief Psychiatric Rating Scale (BPRS) or ot her improvement scales. A meta-analysis of standardized treatment differenc es and a test for homogeneity were performed on four comparator groups: all placebo-controlled trials, all antipsychotic comparator-controlled trials, conventional antipsychotic comparator-controlled trials, and antipsychotic comparator-controlled trials excluding those irt which the dosage for zote pine exceeded 75-300 mg/day (the recommended dose in the UK). The outcome m easure used in the meta-analysis was the change in rating score. RESULTS: Meta-analysis of the placebo-controlled trials showed that a signi ficantly greater reduction in BPRS occurred with zotepine therapy than with placebo therapy. The reduction in rating score was also greater with zotep ine therapy than with antipsychotic comparators. Exclusion of the high-dose zotepine studies did not alter these conclusions. Only in one trial, in wh ich zotepine was compared with the atypical antipsychotic clozapine, was th ere a greater reduction in rating score with the comparator than with zotep ine (not statistically significant). All tests of homogeneity failed to rea ch significance, demonstrating that the data were not influenced by inter-s tudy heterogeneity. CONCLUSION: Zotepine is at least as Effective against all psychopathologica l symptoms of schizophrenia as conventional antipsychotics.