Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia: a meta-analysis of randomised controlled trials

Zheng, Wei; Cai, Dong Bin; Li, Hai Yan; Wu, Yu; Ng, Chee H.; Ungvári, Gábor S.; Xie, Shanshan; Shi, Zhan-Ming; Zhu, Xiao; Ning, Yu; Xiang, Yu‐Tao

doi:10.1136/gpsych-2018-100003

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…The advantage of ARI, and PGD in reducing HPRL is consistent with previous researches [ 33 , 35 , 38 ]. The NMA of Zhang L et al compared the efficacy among ARI, PGD and MET, it indicated that adjunctive ARI (<5 mg) was associated with the most significant reduction in prolactin levels compared to placebo; they also found that adjunctive PGD had the most significant effect in reducing risperidone-induced HPRL; furthermore, adjunctive aripiprazole (<5 mg) had the most significant effect in reducing amisulpride-induced HPRL, while the result was imprecise [ 39 ].…”

Section: Discussionsupporting

confidence: 91%

Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis

Sun

Zhang

et al. 2022

Transl Psychiatry

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Antipsychotic-induced hyperprolactinemia (AP-induced HPRL) occurs overall in up to 70% of patients with schizophrenia, which is associated with hypogonadism and sexual dysfunction. We summarized the latest evidence for the benefits of prolactin-lowering drugs. We performed network meta-analyses to summarize the evidence and applied Grading of Recommendations Assessment, Development, and Evaluation frameworks (GRADE) to rate the certainty of evidence, categorize interventions, and present the findings. The search identified 3,022 citations, 31 studies of which with 1999 participants were included in network meta-analysis. All options were not significantly better than placebo among patients with prolactin (PRL) less than 50 ng/ml. However, adjunctive aripiprazole (ARI) (5 mg: MD = −64.26, 95% CI = −87.00 to −41.37; 10 mg: MD = −59.81, 95% CI = −90.10 to −29.76; more than 10 mg: MD = −68.01, 95% CI = −97.12 to −39.72), switching to ARI in titration (MD = −74.80, 95% CI = −134.22 to −15.99) and adjunctive vitamin B6 (MD = −91.84, 95% CI = −165.31 to −17.74) were associated with significant decrease in AP-induced PRL among patients with PRL more than 50 ng/ml with moderated (adjunctive vitamin B6) to high (adjunctive ARI) certainty of evidence. Pharmacological treatment strategies for AP-induced HPRL depends on initial PRL level. No effective strategy was found for patients with AP-induced HPRL less than 50 ng/ml, while adjunctive ARI, switching to ARI in titration and adjunctive high-dose vitamin B6 showed better PRL decrease effect on AP-induced HPRL more than 50 ng/ml.

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Section: Discussionsupporting

confidence: 91%

Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis

Sun

Zhang

et al. 2022

Transl Psychiatry

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“…org) based on the PRISMA statement. 50 Standardised mean differences (SMDs) with their 95% CIs and risk ratios (RRs) with its 95% CIs were calculated. SMD values over 0.8, 0.5-0.8 and 0.2-0.5 represented large, medium and small effect sizes, respectively.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Effects of ketamine in electroconvulsive therapy for major depressive disorder: meta-analysis of randomised controlled trials

Shi

Wang

et al. 2020

Gen Psych

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BackgroundThe use of ketamine in electroconvulsive therapy (ECT) has been examined in the treatment of major depressive disorder (MDD); however, there has been no systematic review and meta-analysis of related randomised controlled trials (RCTs).AimTo examine the efficacy and safety of ketamine augmentation of ECT in MDD treatment.MethodsTwo reviewers searched Chinese (China National Knowledge Infrastructure and Wanfang) and English (PubMed, PsycINFO, Embase and Cochrane Library) databases from their inception to 23 July 2019. The included studies' bias risk was evaluated using the Cochrane risk of bias assessment tool. The primary outcome of this meta-analysis was improved depressive symptoms at day 1 after a single ECT treatment session. Data were pooled to calculate the standardised mean difference and risk ratio with their 95% CIs using RevMan V.5.3. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the whole quality of evidence.ResultsFour RCTs (n = 239) compared ketamine alone or ketamine plus propofol (n = 149) versus propofol alone (n = 90) in patients with MDD who underwent a single ECT session. Three RCTs were considered as unclear risk with respect to random sequence generation using the Cochrane risk of bias. Compared with propofol alone, ketamine alone and the combination of ketamine and propofol had greater efficacy in the treatment of depressive symptoms at days 1, 3 and 7 after a single ECT session. Moreover, compared with propofol alone, ketamine alone and the combination of ketamine and propofol were significantly associated with increased seizure duration and seizure energy index. Compared with propofol, ketamine alone was significantly associated with increased opening-eye time. Based on the GRADE approach, the evidence level of primary and secondary outcomes ranged from very low (26.7%, 4/15) to ‘low’ (73.3%, 11/15).ConclusionCompared with propofol, there were very low or low evidence levels showing that ketamine alone and the combination of ketamine and propofol appeared to rapidly improve depressive symptoms of patients with MDD undergoing a single ECT session. There is a need for high-quality RCTs.

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“…18 Currently, the evidence supporting the use of PGD in the treatment of antipsychotic-induced hyperprolactinemia is limited. The conclusion of a meta-analysis that included five randomized controlled trials supports the adjunctive use of PGD in patients with hyperprolactinemia; 19 however, the authors also acknowledge that the evidence included has some limitations, and further experiments are still needed to verify the effectiveness of PGD for hyperprolactinemia.…”

Section: Introductionmentioning

confidence: 97%

Peony-Glycyrrhiza Decoction for Antipsychotic-Related Hyperprolactinemia in Patients with Schizophrenia: A Randomized Controlled Trial

Wang¹,

Zheng²,

Fan³

et al. 2023

NDT

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Background: Most antipsychotic drugs are dopamine receptor antagonists that usually lead to abnormal increases in prolactin concentrations and the development of hyperprolactinemia (HPRL), which in turn causes sexual dysfunction in patients. Peony-Glycyrrhiza Decoction (PGD) enhanced dopamine D2 receptors (DRD2) and dopamine transporter (DAT) and significantly reversed the expression of DRD2 and DAT. Therefore, we hypothesized that PGD might effectively improve hyperprolactinemia and alleviate sexual dysfunction in patients. Methods: We performed an 8-week randomized controlled study on 62 subjects with schizophrenia who were randomized into two groups. The experimental group was treated with the PGD intervention, and the control group did not receive treatment. The primary outcome indicators were the levels of sex hormones and the total Arizona Sexual Experience Scale (ASEX) score. Results: There was a significant difference in PRL levels between the two groups at weeks 4 and 8. From the beginning to the end of the experiment, there was a significant increase in PRL levels in the control group, while there was no significant change in the experimental group. The ASEX scale assessed sexual function in both groups, and patients in the experimental group showed an improvement in sexual function at week 8. During the experiment, the two groups found no differences between Positive and Negative Syndrome Scale (PANSS) scores and Treatment Emergent Symptom Scale (TESS) scores. Conclusion: PGD significantly improved the patient's sexual function but was less effective in reducing prolactin levels and may prevent further increases in prolactin levels.

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Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia: a meta-analysis of randomised controlled trials

Cited by 7 publications

References 35 publications

Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis

Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis

Effects of ketamine in electroconvulsive therapy for major depressive disorder: meta-analysis of randomised controlled trials

Peony-Glycyrrhiza Decoction for Antipsychotic-Related Hyperprolactinemia in Patients with Schizophrenia: A Randomized Controlled Trial

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