College of Psychiatric and Neurologic Pharmacists

Publication year: 2012Source:Journal of Affective DisordersPaul B. Fitzgerald, Kate E. Hoy, Sally E. Herring, Susan McQueen, Amy V.J. Peachey, Rebecca A. Segrave, Jerome Maller, Phillip Hall, Z. Jeff Daskalakis

Andrea Cipriani and colleagues' network meta-analysis of drug treatments in acute mania (Oct 8, p 1306) suggests that, overall, antipsychotic drugs are more efficacious than are mood stabilisers. In deriving these results, Cipriani and colleagues included studies that used combination therapy as well as those comparing monotherapy strategies.

The meta-analysis by Andrea Cipriani and colleagues contains two important limitations: (1) the interpretation of all-cause discontinuation at week 3 as “the most sensible and sensitive estimate” of treatment acceptability; and (2) the failure to consider important clinical differences between the study populations investigated.

Paul Glue and Greg Tarr, and Alain Dervaux and Xavier Laqueille, raise issues relating to our exclusion from the review of combination treatments and patients with a dual diagnosis. Although interesting and clinically important, these questions were not our focus. We studied the relative efficacy and acceptability of individual compounds, not different treatment strategies. This is a well established way to investigate such clinical questions, and we have analysed the effect of combination designs in a preplanned sensitivity analysis.