Key result
Antipsychotics increase tachycardia risk by ~83% vs placebo in acute schizophrenia.
Why the study?
Antipsychotics can cause changes in heart rate, but this has never been systematically examined.
Does treatment with antipsychotics increase the risk of tachycardia and bradycardia events in adults with acute schizophrenia?
Meta-Analysis (n=16,907)
Double-blind, single-blind, and open-label
Randomized controlled trials
Does treatment with antipsychotics increase the risk of tachycardia and bradycardia events in adults with acute schizophrenia?
Relative Risk: 1.83 (95% CI 1.4–2.41)
Number Needed to Treat: 43
p-value: p=<0.001
Antipsychotic treatment for acute schizophrenia significantly increases the risk of tachycardia events, suggesting a need for close monitoring in patients with cardiac risk factors.
Antipsychotics increase tachycardia risk in acute schizophrenia; confirms prior observational signals and supports monitoring in patients with cardiac risk factors.
Background: Antipsychotics are the treatment of choice in the therapy of schizophrenia. These drugs can be associated with changes in heart rate, but this question has never been examined systematically. Objective: We aimed to analyse changes in heart rate during treatment with antipsychotics using the frequency of tachycardia and bradycardia events. Design: For this systematic review and meta-analysis, we included all randomized controlled trials for the acute treatment of schizophrenia comparing antipsychotics head-to-head or with placebo. Data Sources and Methods: We searched Embase, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (last search June 2021). Two authors independently selected studies and extracted data. We conducted pairwise meta-analyses using a random-effects model. Outcomes were tachycardia and bradycardia events. Results: We found 469 trials meeting the inclusion criteria. Seventy-seven studies with 16,907 participants provided data on tachycardia or bradycardia events. We found no significant differences between antipsychotics and placebo or between antipsychotics for bradycardia events based on sparse data. Antipsychotics had a higher risk for tachycardia events compared with placebo [ N = 37, n = 7827, risk ratio (RR) = 1.83, 95% confidence interval (CI) = 1.40–2.41], with large differences between the individual substances (iloperidone RR = 14.05, chlorpromazine RR = 4.84, loxapine RR = 4.52, risperidone RR = 3.38, quetiapine RR = 2.64, paliperidone RR = 1.65). Some head-to-head comparisons were also significantly different: olanzapine versus haloperidol RR = 2.87, chlorpromazine versus thiothixene RR = 2.92, quetiapine versus lurasidone RR = 3.22, risperidone versus aripiprazole RR = 4.37, iloperidone versus ziprasidone RR = 4.65). Conclusion: Many studies do not report data for cardiac outcomes, but the available evidence indicates that treatment with antipsychotics raises the risk for tachycardia. Therefore, especially patients with cardiac risk factors should be monitored closely during antipsychotic treatment. Registration: PROSPERO: CRD42014014919
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Huhn et al. (2022) conducted a meta-analysis in Schizophrenia (n=16,907). Antipsychotics vs. Placebo was evaluated on Tachycardia events (RR 1.83, 95% CI 1.40-2.41, p=<0.001). Treatment with antipsychotics significantly increased the risk of tachycardia compared with placebo (RR 1.83) in adults with acute schizophrenia, with a number needed to harm of 43.
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