TY  - JOUR
AU  - Schneider-Thoma, Johannes
AU  - Zhu, Yikang
AU  - Qin, Mengchang
AU  - Dong, Yu
AU  - Guan, Shiwei
AU  - Wang, Jiaxi
AU  - Tian, Jing
AU  - Lin, Xiao
AU  - Rodolico, Alessandro
AU  - Siafis, Spyridon
AU  - Bighelli, Irene
AU  - Wehner, Melanie
AU  - Veith, Christina
AU  - Krayer, Felix
AU  - Scheuring, Elfriede
AU  - Davis, John M
AU  - Priller, Josef
AU  - Nikolakopoulou, Adriani
AU  - Salanti, Georgia
AU  - Li, Chunbo
AU  - Leucht, Stefan
TI  - Comparative efficacy and tolerability of antidopaminergic and muscarinic antipsychotics for acute schizophrenia: a network meta-analysis of randomised controlled trials indexed in international English and Chinese databases.
JO  - The lancet
VL  - 407
IS  - 10531
SN  - 0140-6736
CY  - London [u.a.]
PB  - Elsevier
M1  - DZNE-2026-00229
SP  - 876 - 891
PY  - 2026
AB  - Antipsychotic drugs are the established treatment for acute schizophrenia but differ in receptor-binding profiles. In 2024, a new-in-class muscarinic receptor agonist (xanomeline-trospium) was licenced, acting upstream of antidopaminergic agents, and providing hope to decrease the adverse effects burden of antipsychotics. We aimed to compare the efficacy and tolerability of antipsychotics by performing network meta-analysis of randomised controlled trials (RCTs).This systematic review (PROSPERO, CRD42022380708) included blinded and open RCTs investigating antipsychotic drugs in participants of any age with acute psychotic symptoms of schizophrenia over 3 weeks to 3 months. Included antipsychotics comprised 23 primarily dopamine-receptor blocking medications and the muscarinic receptor agonist xanomeline-trospium in different applications. We searched Cochrane Schizophrenia group's register, previous reviews, and five Chinese databases for trials published from database inception until July 26, 2024 and contacted authors to assess trials' methodological quality; only trials with appropriate randomisation indicated were included. The primary outcome was rating scale-measured overall symptoms of schizophrenia (efficacy) analysed with random-effects frequentist network meta-analysis. Secondary outcomes comprised 32 further efficacy and tolerability outcomes. The confidence in the estimates was assessed using the Confidence in Network Meta-Analysis approach.After screening 18 859 references and contacting authors of 5428 trials, we included 438 RCTs. Of those, 388 RCTs with 78 193 participants (28 448 women and 49 745 men) provided usable data for at least one outcome. 5117 Chinese trials were identified but most were excluded because authors did not reply or reported serious methodological concerns. 256 double-blind studies with 58 948 participants provided usable data for the primary outcome. All antipsychotics reduced symptoms more than placebo with standardised mean differences ranging from -0·90 (95
LB  - PUB:(DE-HGF)16
C6  - pmid:41763745
DO  - DOI:10.1016/S0140-6736(25)02365-7
UR  - https://pub.dzne.de/record/285365
ER  -