Adjunctive reboxetine for schizophrenia: Meta-analysis of randomized double-blind, placebo-controlled trials
Zheng, W., Li, X., Shi, Z., Yang, X., Cai, D., Ng, C. H., Ungvari, G. S., Liu, W., Wu, Y., Wang, Y., Ning, Y., & Xiang, Y. (2020). Adjunctive reboxetine for schizophrenia: Meta-analysis of randomized double-blind, placebo-controlled trials. Pharmacopsychiatry, 53 (1), 5-13.
Background: Results of previous studies on the safety and efficacy of adjunctive reboxetine for schizophrenia have been inconsistent.
Aim: The aim of this study was to examine the efficacy and tolerability of reboxetine as an adjunct medication to antipsychotic treatment in a meta-analysis of randomized controlled trials (RCTs).
Methods: Two independent investigators extracted data for a random effects meta-analysis and assessed the quality of studies using risk of bias and the Jadad scale. Weighted and standardized mean differences (WMDs/SMDs) and risk ratio (RR)±95% confidence intervals (CIs) were calculated.
Results: Nine RCTs (n=630) with double-blind design were identified. Reboxetine outperformed placebo in improving negative (9 RCTs, n=602, SMD: −0.47 [95% CI: −0.87, −0.07], p=0.02; I2=82%), but not the overall, positive, and general psychopathology scores. The significant therapeutic effect on negative symptoms disappeared in the sensitivity analysis after removing an outlying study and in 50% (6/12) of the subgroup analyses. Reboxetine outperformed placebo in reducing weight (3 RCTs, n=186, WMD: −3.83 kg, p=0.04; I2=92%) and body mass index (WMD: −2.23 kg/m2, p=0.04; I2=95%). Reboxetine caused dry mouth but was associated with less weight gain overall and weight gain of ≥7% of the initial weight. All-cause discontinuation and other adverse events were similar between reboxetine and placebo.
Conclusion: Adjunctive reboxetine could be useful for attenuating antipsychotic-induced weight gain, but it was not effective in treating psychopathology including negative symptoms in schizophrenia.
reboxetine, schizophrenia, psychopathology, weight gain, meta-analysis