Few studies have studied clozapine as a first- or second-line treatment modality in schizophrenia spectrum disorders.Only large clinical trials may comprehensively probe disease stage-dependent superiority of clozapine and investigate overall tolerability. The few eligible trials on this topic suggest that clozapine may be more effective than other antipsychotics when used as first- or second-line treatment. In addition, a sensitivity analysis revealed a significant benefit of clozapine over risperidone (Hedges’ g = 0.274, P = 0.030, 95% CI = 0.027–0.521). Our meta-analysis comparing clozapine to a miscellaneous group of antipsychotics revealed a significant benefit of clozapine (Hedges’ g = 0.220, P = 0.026, 95% CI = 0.026–0.414), with no evidence of heterogeneity. Resultsįifteen articles were eligible for the systematic review ( N = 314 subjects on clozapine and N = 800 on other antipsychotics). We performed random-effects meta-analyses. MethodsĪrticles were eligible if they investigated clozapine compared to another antipsychotic as a first- or second-line treatment in non-treatment-resistant schizophrenia spectrum disorders (SCZ) patients and provided data on treatment response. This systematic review and meta-analysis therefore focus on the use of clozapine as first-line or second-line treatment in non-treatment-resistant patients. No consensus exists on whether clozapine should be prescribed in early stages of psychosis.
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