Hundreds of randomized controlled trials have been conducted to test the efficacy of the multiple forms of polypharmacy in various symptom domains of psychoses.
The correct answer is E. None of the above
Hundreds of randomized controlled trials have been conducted to test the efficacy of the multiple forms of polypharmacy in various symptom domains of psychoses. These trials are often meta-analyzed as a way of obtaining unique pooled effects, which are often considered more reliable than those obtained from individual studies.
In one study, Correll and colleagues1 looked at the recommendations that resulted from the meta-analyses. Out of 42 co-treatment strategies that had been included, 14 combination treatments were found superior to antipsychotic monotherapy. Unfortunately, there was meaningful risk of bias in most of the randomized trials. This risk was even higher for the studies of combinations that showed large benefits compared with monotherapy.
The authors concluded that none of the recommended combinations had a meaningful benefit compared with their monotherapy counterparts. Those that showed benefit, had important risk of bias that did not justify the recommendation of drug combination for any of the symptom domains in schizophrenia. This is particularly disappointing for cognitive or negative symptoms that show limited benefit from antipsychotics monotherapy yet are very burdensome. These findings suggest that large high-quality trials are still necessary to address this issue.
For more on this topic, see Understanding the Risks and Benefits of Antipsychotic Polypharmacy, on which this quiz is based.
1. Correll CU, Rubio JM, Inczedy-Farkas G, et al. Efficacy of 42 pharmacologic co-treatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. JAMA Psychiatry. 2017;74:675.