ECT boosts clozapine in treatment-resistant schizophrenia

  • J Psychiatr Res

  • curated by Jim Kling
  • Clinical Essentials
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Takeaway

  • In treatment-resistant schizophrenia (TRS), the addition of electroconvulsive therapy (ECT) to clozapine (e.g., Clozaril) yielded medium to large effects on symptoms compared with clozapine alone, according to a meta-analysis.
  • Memory impairment and headache occurred with ECT but were infrequent and generally mild and transient.

Why this matters

  • The study is the largest meta-analysis of ECT supplementation of clozapine in TRS.
  • Unlike previous meta-analyses, this study included Chinese studies that are not readily available.

Study design

  • Meta-analysis of 18 randomized controlled trials (RCTs) evaluating the efficacy and safety of the ECT-clozapine combination for TRS.
  • Funding: None disclosed.

Key results

  • The ECT-clozapine combination (n=384) had superior (moderate to large) effects on symptoms of TRS vs clozapine alone (n=355) in terms of:
    • early symptomatic improvement (1-2 weeks): standardized mean difference (SMD), −0.54; I2, 77%; P=.002; 8 RCTs;
    • post-ECT assessment (4-12 weeks): SMD, −0.88; I2, 86%; P=.0001; 10 RCTs; and
    • endpoint assessment after follow-up post-ECT (1-10 weeks): SMD, −1.44; I2, 95%; P<.00001 rcts.>
  • ECT-clozapine combination vs clozapine alone often showed:
    • memory impairment (risk ratio [RR], 16.10; I2, 0%; P<.0001 number needed to harm and>
    • headache (RR, 4.03; I2, 0%; P=.005; NNH, 8).

Limitations

  • Significant heterogeneity in results.

Coauthored with Chitra Ravi, MPharm

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