Abstract：
OBJECTIVE: The aim of this study is to indirectly compare and rank the different drugs that have been studied in randomized clinical trials (RCTs) in patients with tardive dyskinesia (TD) in terms of their efficacy in ameliorating the symptoms of TD and safety.
METHODS: A network meta-analysis and a systematic review were registered prospectively on PROSPERO under the ID: CRD42023407823 and were conducted in accordance with the PRISMA-NMA guidelines.
METHODS: PubMed, Scopus, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Sciences, and Clinicaltrials.gov were searched to identify relevant records.
METHODS: Any parallel randomized blinded controlled clinical trials that studied the use of any medications in treating TD and assessed the symptoms using a functional scale that has been previously validated.
METHODS: The standardized mean difference of improvement along with the reported adverse events for each drug was extracted from each trial, and a network meta-analysis was conducted using a random-effects model.
RESULTS: One thousand eight hundred seventeen patients in 33 RCTs were included in the analysis. Twenty-three different drugs were compared to placebo in terms of reduction in TD symptoms. Among these, valbenazine 80 mg (SMD = - 1.66, 95%CI = [- 2.55; - 0.78]), valbenazine 40 mg (- 1.00, [- 1.89; - 0.11]), and vitamin E (- 0.77, [- 1.45; - 0.1]) significantly reduced TD symptoms in comparison to placebo, while deutetrabenazine 36 mg (- 1.00, [- 2.12; 0.11]) and reserpine (- 0.54, [- 1.09; 0.02]) did not significantly reduce symptoms. Some serious adverse events were reported for valbenazine and deutetrabenazine, which included mainly psychiatric symptoms such as depression, worsening of schizophrenia, and suicidal ideation, while mild adverse events were reported for other drugs, and their incidence in the treatment arms was comparable to those in the placebo arm.
CONCLUSIONS: Valbenazine (80 and 40 mg) and vitamin E demonstrated efficacy in treating tardive dyskinesia. However, the significant side effects of valbenazine should prompt further investigation of alternative treatment modalities.
METHODS: A network meta-analysis and a systematic review were registered prospectively on PROSPERO under the ID: CRD42023407823 and were conducted in accordance with the PRISMA-NMA guidelines.
METHODS: PubMed, Scopus, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Sciences, and Clinicaltrials.gov were searched to identify relevant records.
METHODS: Any parallel randomized blinded controlled clinical trials that studied the use of any medications in treating TD and assessed the symptoms using a functional scale that has been previously validated.
METHODS: The standardized mean difference of improvement along with the reported adverse events for each drug was extracted from each trial, and a network meta-analysis was conducted using a random-effects model.
RESULTS: One thousand eight hundred seventeen patients in 33 RCTs were included in the analysis. Twenty-three different drugs were compared to placebo in terms of reduction in TD symptoms. Among these, valbenazine 80 mg (SMD = - 1.66, 95%CI = [- 2.55; - 0.78]), valbenazine 40 mg (- 1.00, [- 1.89; - 0.11]), and vitamin E (- 0.77, [- 1.45; - 0.1]) significantly reduced TD symptoms in comparison to placebo, while deutetrabenazine 36 mg (- 1.00, [- 2.12; 0.11]) and reserpine (- 0.54, [- 1.09; 0.02]) did not significantly reduce symptoms. Some serious adverse events were reported for valbenazine and deutetrabenazine, which included mainly psychiatric symptoms such as depression, worsening of schizophrenia, and suicidal ideation, while mild adverse events were reported for other drugs, and their incidence in the treatment arms was comparable to those in the placebo arm.
CONCLUSIONS: Valbenazine (80 and 40 mg) and vitamin E demonstrated efficacy in treating tardive dyskinesia. However, the significant side effects of valbenazine should prompt further investigation of alternative treatment modalities.
摘要：
目的：本研究的目的是间接比较随机临床试验（RCTs）中研究的不同药物对迟发性运动障碍（TD）患者改善TD症状的疗效和安全性。
方法：在PROSPERO上前瞻性注册了ID：CRD42023407823的网络荟萃分析和系统评价，并按照PRISMA-NMA指南进行。
方法：PubMed，Scopus,Cochrane中央对照试验登记册（CENTRAL），WebofSciences,和Clinicaltrials.gov进行了搜索，以确定相关记录。
方法：任何平行随机盲法对照临床试验，研究任何药物治疗TD的使用，并使用先前已验证的功能量表评估症状。
方法：从每个试验中提取每种药物的改善和报告的不良事件的标准化平均差，使用随机效应模型进行网络荟萃分析。
结果：分析包括33个随机对照试验中的一千八百十七名患者。在减少TD症状方面，将23种不同的药物与安慰剂进行了比较。其中,缬草那嗪80毫克（SMD=-1.66，95CI=[-2.55；-0.78]），缬草那嗪40毫克（-1.00，[-1.89；-0.11]），与安慰剂相比，维生素E（-0.77，[-1.45;-0.1]）显着减少了TD症状，而对丁苯那嗪36mg（-1.00，[-2.12;0.11]）和利血平（-0.54，[-1.09;0.02]）并未显着减轻症状。据报道，缬草那嗪和杜丁苯那嗪发生了一些严重不良事件，主要包括精神症状，如抑郁症，精神分裂症的恶化，和自杀意念，虽然其他药物报告了轻度不良事件，它们在治疗组中的发病率与安慰剂组中的发病率相当。
结论：缬草嗪（80和40mg）和维生素E在治疗迟发性运动障碍方面具有疗效。然而,缬草那嗪的显著副作用应促使进一步研究替代治疗方式.
方法：在PROSPERO上前瞻性注册了ID：CRD42023407823的网络荟萃分析和系统评价，并按照PRISMA-NMA指南进行。
方法：PubMed，Scopus,Cochrane中央对照试验登记册（CENTRAL），WebofSciences,和Clinicaltrials.gov进行了搜索，以确定相关记录。
方法：任何平行随机盲法对照临床试验，研究任何药物治疗TD的使用，并使用先前已验证的功能量表评估症状。
方法：从每个试验中提取每种药物的改善和报告的不良事件的标准化平均差，使用随机效应模型进行网络荟萃分析。
结果：分析包括33个随机对照试验中的一千八百十七名患者。在减少TD症状方面，将23种不同的药物与安慰剂进行了比较。其中,缬草那嗪80毫克（SMD=-1.66，95CI=[-2.55；-0.78]），缬草那嗪40毫克（-1.00，[-1.89；-0.11]），与安慰剂相比，维生素E（-0.77，[-1.45;-0.1]）显着减少了TD症状，而对丁苯那嗪36mg（-1.00，[-2.12;0.11]）和利血平（-0.54，[-1.09;0.02]）并未显着减轻症状。据报道，缬草那嗪和杜丁苯那嗪发生了一些严重不良事件，主要包括精神症状，如抑郁症，精神分裂症的恶化，和自杀意念，虽然其他药物报告了轻度不良事件，它们在治疗组中的发病率与安慰剂组中的发病率相当。
结论：缬草嗪（80和40mg）和维生素E在治疗迟发性运动障碍方面具有疗效。然而,缬草那嗪的显著副作用应促使进一步研究替代治疗方式.
