Pimozide for schizophrenia or related psychoses.
Author(s): Mothi M(1), Sampson S.
Affiliation(s): Author information:
(1)General Adult Psychiatry, Newsam Centre, Seacroft Hospital, Leeds and York NHS
Foundation Trust, York Road, Leeds, UK, LS14 6WB.
Publication date & source: 2013, Cochrane Database Syst Rev. , 11:CD001949
BACKGROUND: Pimozide, formulated in the 1960s, continues to be marketed for the
care of people with schizophrenia or related psychoses such as delusional
disorder. It has been associated with cardiotoxicity and sudden unexplained
death. Electrocardiogram monitoring is now required before and during use.
OBJECTIVES: To review the effects of pimozide for people with schizophrenia or
related psychoses in comparison with placebo, no treatment or other antipsychotic
medication.A secondary objective was to examine the effects of pimozide for
people with delusional disorder.
SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Register (28
January 2013).
SELECTION CRITERIA: We sought all relevant randomised clinical trials (RCTs)
comparing pimozide with other treatments.
DATA COLLECTION AND ANALYSIS: Working independently, we inspected citations,
ordered papers and then re-inspected and assessed the quality of the studies and
of extracted data. For homogeneous dichotomous data, we calculated the relative
risk (RR), the 95% confidence interval (CI) and mean differences (MDs) for
continuous data. We excluded data if loss to follow-up was greater than 50%. We
assessed risk of bias for included studies and used GRADE to rate the quality of
the evidence.
MAIN RESULTS: We included 32 studies in total: Among the five studies that
compared pimozide versus placebo, only one study provided data for global state
relapse, for which no difference between groups was noted at medium term (1 RCT n
= 20, RR 0.22 CI 0.03 to 1.78, very low quality of evidence). None of the five
studies provided data for no improvement or first-rank symptoms in mental state.
Data for extrapyramidal symptoms demonstrate no difference between groups for
Parkinsonism (rigidity) at short term (1 RCT, n = 19, RR 5.50 CI 0.30 to 101.28,
very low quality of evidence) or at medium term (1 RCT n = 25, RR 1.33 CI 0.14 to
12.82, very low quality of evidence), or for Parkinsonism (tremor) at medium term
(1 RCT n = 25, RR 1 CI 0.2 to 4.95, very low quality of evidence). No data were
reported for quality of life at medium term.Of the 26 studies comparing pimozide
versus any antipsychotic, seven studies provided data for global state relapse at
medium term, for which no difference was noted (7 RCTs n = 227, RR 0.82 CI 0.57
to 1.17, moderate quality of evidence). Data from one study demonstrated no
difference in mental state (no improvement) at medium term (1 RCT n = 23, RR 1.09
CI 0.08 to 15.41, very low quality evidence); another study demonstrated no
difference in the presence of first-rank symptoms at medium term (1 RCT n = 44,
RR 0.53 CI 0.25 to 1.11, low quality of evidence). Data for extrapyramidal
symptoms demonstrate no difference between groups for Parkinsonism (rigidity) at
short term (6 RCTs n = 186, RR 1.21 CI 0.71 to 2.05,low quality of evidence) or
medium term (5 RCTs n = 219, RR 1.12 CI 0.24 to 5.25,low quality of evidence), or
for Parkinsonism (tremor) at medium term (4 RCTs n = 174, RR 1.46 CI 0.68 to
3.11, very low quality of evidence). No data were reported for quality of life at
medium term.In the one study that compared pimozide plus any antipsychotic versus
the same antipsychotic, significantly fewer relapses were noted in the augmented
pimozide group at medium term (1 RCT n = 69, RR 0.28 CI 0.15 to 0.50, low quality
evidence). No data were reported for mental state outcomes or for extrapyramidal
symptoms (EPS). Data were skewed for quality of life scores, which were not
included in the meta-analysis but were presented separately.Two studies compared
pimozide plus any antipsychotics versus antipsychotic plus placebo; neither study
reported data for outcomes of interest, apart from Parkinsonism at medium term
and quality of life using the Specific Level of Functioning scale (SLOF);
however, data were skewed.Only one study compared pimozide plus any antipsychotic
versus antipsychotics plus antipsychotic; no data were reported for global state
and mental state outcomes of interest. Data were provided for Parkinsonism
(rigidity and tremor) using the Extrapyramidal Symptom Rating Scale (ESRS);
however, these data were skewed.
AUTHORS' CONCLUSIONS: Although shortcomings in the data are evident, enough
overall consistency over different outcomes and time scales is present to confirm
that pimozide is a drug with efficacy similar to that of other, more commonly
used antipsychotic drugs such as chlorpromazine for people with schizophrenia. No
data support or refute its use for those with delusional disorder.
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