Efficacy and safety of xanomeline-trospium chloride in schizophrenia: A systematic review and meta-analysis

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2025-01-01 DOI:10.1016/j.jpsychires.2024.11.047

Artur Menegaz de Almeida , Fernanda Moraes Tamashiro , Maria Eduarda Cavalcanti Souza , Iasmin Isabelli Luiz Silvério , Celso de Almeida Souza Miranda , Ítalo Barros Andrade , Michele Kreuz , Francisco Cezar Aquino de Moraes , Francinny Alves Kelly

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引用次数: 0

Abstract

Introduction

Schizophrenia is one of the psychiatric illnesses with a higher mortality rate. Xanomeline, an oral muscarinic receptor agonist, combined with Trospium, a pan-muscarinic receptor antagonist, represents a promising new treatment for schizophrenia that has been tested in clinical trials. Herein, we aimed to perform a meta-analysis assessing Xanomeline-Trospium Chloride's (XTC) safety and efficacy for treating schizophrenia.

Materials and methods

MEDLINE, EMBASE, and Cochrane databases were searched for randomized clinical trials testing XTC safety and efficacy in patients with schizophrenia on May 03, 2024. The research protocol was registered with the International Prospective Register of Systematic Reviews (CRD42024547487). Data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I² statistics. R, version 4.3.2, was used for statistical analysis.

Results

3 RCTs and 674 patients were included, of whom 332 (49%) received XTC. The change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score was significantly higher in the XTC arm (MD -13.17; 95% CI -20.16 to −6.18; P = 0.0002; I² = 100%). Treatment with XTC resulted in improvements across all subscales of the PANSS. Additionally, XTC was associated with the occurrence of cholinergic adverse events, including nausea (18,52% vs. 3,79%; RR 4.37; 95% CI 2.43 to 7.84; P < 0.000001; I² = 19%) but was not associated with akathisia (MD -0.00; 95% CI -0.13 to 0.13; P = 0.9; I² = 0%) or body weight gain (MD -0.36; 95% CI -1.18 to 0.46; P = 0.38; I² = 51%).

Conclusion

XTC is effective in improving schizophrenia symptoms. However, it is associated with some bothersome AEs that may undermine its tolerability and lead to increased discontinuation rates, despite its efficacy.

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氯曲霉碱治疗精神分裂症的疗效和安全性：一项系统综述和荟萃分析。

精神分裂症是致死率较高的精神疾病之一。口服毒蕈碱受体激动剂Xanomeline与泛毒蕈碱受体拮抗剂Trospium联合，代表了一种有希望的精神分裂症新治疗方法，已在临床试验中进行了测试。在此，我们旨在进行荟萃分析，评估Xanomeline-Trospium Chloride （XTC）治疗精神分裂症的安全性和有效性。材料和方法：检索MEDLINE、EMBASE和Cochrane数据库，于2024年5月3日检索XTC对精神分裂症患者安全性和有效性的随机临床试验。该研究方案已在国际前瞻性系统评价注册（CRD42024547487）注册。资料采用Mantel-Haenszel法和95% ci进行检验。采用I2统计量评估异质性。采用4.3.2版本的R软件进行统计分析。结果：纳入3项随机对照试验，674例患者，其中332例（49%）接受XTC治疗。阳性和阴性综合征量表（PANSS）总分与基线相比，XTC组的变化明显更高(MD -13.17；95% CI -20.16 ~ -6.18；p = 0.0002；i2 = 100%)。XTC治疗可改善PANSS的所有亚量表。此外，XTC与胆碱能不良事件的发生有关，包括恶心(18.52% vs. 3.79%；RR 4.37;95% CI 2.43 ~ 7.84；P 2 = 19%)，但与静坐症无关(MD -0.00；95% CI -0.13 ~ 0.13；p = 0.9；I2 = 0%)或体重增加(MD -0.36；95% CI -1.18 ~ 0.46；p = 0.38；i2 = 51%)。结论：XTC能有效改善精神分裂症的症状。然而，它与一些令人烦恼的不良反应有关，这些不良反应可能会破坏其耐受性，并导致停药率增加，尽管它很有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;