Murilo Marmori Cruccioli, Pedro Henrique Teixeira Carneiro, Jorge Ferreira Jasmineiro Pitanga, Camila Carneiro Ferreira, Regina Carneiro Leão, Milena Lima Loures, Caio Rezende Lima, Pedro Fraiman, Filipe P Sarmento
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However, despite increasing access to atypical antipsychotics in hospital settings, robust analyses of studies comparing the effectiveness of haloperidol and atypical antipsychotics are lacking.</p><p><strong>Objectives: </strong>To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the effectiveness and safety of haloperidol versus atypical antipsychotics in the management of delirium patients.</p><p><strong>Methods: </strong>We conducted a systematic search of Medline, Scopus, and Cochrane for RCTs comparing atypical antipsychotics with haloperidol in delirium patients. Odds ratio (OR) was used to analyze dichotomous variables. Continuous outcomes were compared using mean difference (MD) and standardized mean difference (SMD). The random effects model was applied to all endpoints.</p><p><strong>Results: </strong>Eleven RCTs (n=1450 patients) met the eligibility criteria. 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However, patients treated with haloperidol had significantly higher odds of experiencing extrapyramidal symptoms compared with those treated with atypical antipsychotics (OR, 2.72; [95% CI, 1.26-5.87]; P = 0.01).</p><p><strong>Conclusions: </strong>While there were no significant differences in the effectiveness between treatments, patients treated with haloperidol had nearly a 3-fold increase in the incidence of extrapyramidal symptoms, indicating a potential advantage of atypical antipsychotics in minimizing adverse effects.</p>","PeriodicalId":10449,"journal":{"name":"Clinical Neuropharmacology","volume":" ","pages":"145-150"},"PeriodicalIF":1.5000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Haloperidol Versus Atypical Antipsychotics for Delirium in Hospitalized and ICU Patients: A Systematic Review and Meta-analysis.\",\"authors\":\"Murilo Marmori Cruccioli, Pedro Henrique Teixeira Carneiro, Jorge Ferreira Jasmineiro Pitanga, Camila Carneiro Ferreira, Regina Carneiro Leão, Milena Lima Loures, Caio Rezende Lima, Pedro Fraiman, Filipe P Sarmento\",\"doi\":\"10.1097/WNF.0000000000000650\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>While there is still debate over the benefit of antipsychotics in delirium management, surveys indicate their frequent use in clinical practice. 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引用次数: 0
摘要
背景:虽然抗精神病药物在谵妄治疗中的益处仍存在争议,但调查表明它们在临床实践中使用频繁。以前的系统评价和荟萃分析集中在评估抗精神病药物与安慰剂在谵妄管理中的有效性。然而,尽管在医院环境中越来越多地获得非典型抗精神病药物,但缺乏比较氟哌啶醇和非典型抗精神病药物有效性的强有力的研究分析。目的:对随机对照试验(rct)进行系统回顾和荟萃分析,比较氟哌啶醇与非典型抗精神病药物治疗谵妄患者的有效性和安全性。方法:我们对Medline、Scopus和Cochrane进行了系统检索,比较非典型抗精神病药物与氟哌啶醇治疗谵妄患者的随机对照试验。比值比(OR)用于分析二分类变量。使用平均差(MD)和标准化平均差(SMD)比较连续结果。随机效应模型应用于所有端点。结果:11项rct (n=1450例)符合入选标准。谵妄严重程度(SMD, -0.03; [95% CI, -0.20 ~ 0.15]; P = 0.78)和总死亡率(OR, 1.26; [95% CI, 0.88 ~ 1.80]; P = 0.20)组间无显著差异。然而,与非典型抗精神病药物治疗的患者相比,氟哌啶醇治疗的患者出现锥体外系症状的几率明显更高(OR, 2.72; [95% CI, 1.26-5.87]; P = 0.01)。结论:虽然两种治疗方法的有效性没有显著差异,但氟哌啶醇治疗的患者锥体外系症状的发生率增加了近3倍,这表明非典型抗精神病药物在减少不良反应方面具有潜在的优势。
Haloperidol Versus Atypical Antipsychotics for Delirium in Hospitalized and ICU Patients: A Systematic Review and Meta-analysis.
Background: While there is still debate over the benefit of antipsychotics in delirium management, surveys indicate their frequent use in clinical practice. Previous systematic reviews and meta-analyses have focused on assessing the effectiveness of antipsychotics versus placebo in delirium management. However, despite increasing access to atypical antipsychotics in hospital settings, robust analyses of studies comparing the effectiveness of haloperidol and atypical antipsychotics are lacking.
Objectives: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the effectiveness and safety of haloperidol versus atypical antipsychotics in the management of delirium patients.
Methods: We conducted a systematic search of Medline, Scopus, and Cochrane for RCTs comparing atypical antipsychotics with haloperidol in delirium patients. Odds ratio (OR) was used to analyze dichotomous variables. Continuous outcomes were compared using mean difference (MD) and standardized mean difference (SMD). The random effects model was applied to all endpoints.
Results: Eleven RCTs (n=1450 patients) met the eligibility criteria. Delirium severity (SMD, -0.03; [95% CI, -0.20 to 0.15]; P = 0.78) and overall mortality (OR, 1.26; [95% CI, 0.88-1.80]; P = 0.20) did not differ significantly between groups. However, patients treated with haloperidol had significantly higher odds of experiencing extrapyramidal symptoms compared with those treated with atypical antipsychotics (OR, 2.72; [95% CI, 1.26-5.87]; P = 0.01).
Conclusions: While there were no significant differences in the effectiveness between treatments, patients treated with haloperidol had nearly a 3-fold increase in the incidence of extrapyramidal symptoms, indicating a potential advantage of atypical antipsychotics in minimizing adverse effects.
期刊介绍:
Clinical Neuropharmacology is a peer-reviewed journal devoted to the pharmacology of the nervous system in its broadest sense. Coverage ranges from such basic aspects as mechanisms of action, structure-activity relationships, and drug metabolism and pharmacokinetics, to practical clinical problems such as drug interactions, drug toxicity, and therapy for specific syndromes and symptoms. The journal publishes original articles and brief reports, invited and submitted reviews, and letters to the editor. A regular feature is the Patient Management Series: in-depth case presentations with clinical questions and answers.