Treatments for bipolar disorder: can number needed to treat/harm help inform clinical decisions?

Abstract

Clinical trials can help inform clinical decision making by quantifying the likelihood of benefit vs. harm. Integrating such data with individual patient circumstances, values, and preferences can help optimize treatment choices.

Antipsychotic Agents

“…Ideally, meta-analysis relies primarily on results of well-designed, randomized, controlled therapeutic trials, and attempts to combine fi ndings from studies that appear to be comparable. Typically, the results of individual trials are weighted, usually by the numbers of subjects and sometimes also for measurement variance, to produce an overall, pooled, estimate of effect size that can be a rate ratio (RR; such as response rates based on attaining a criterion [typically ³ 50%] of improvement with drug vs. placebo) or an outcome difference, such as difference in response rate (RD) between a drug and placebo control (the reciprocal of which is the number-needed-to-treat [NNT] to produce an effect superior to that associated with placebo, or the numberneeded-to-harm [NNH] in the case of an adverse effect as the outcome), or difference in percentage change on a standard symptom rating scale [ 110 ] .…”

Cariprazine in Bipolar Disorder: Clinical Efficacy, Tolerability, and Place in Therapy

“…The agents themselves vary greatly in terms of ease of use and tolerability [1,2]. [22], and a systematic review with emphasis on the chemistry, pharmacodynamics, and pharmacokinetics of cariprazine [23].…”

“…Moreover, although most available treatments are approved for the treatment of acute mania, fewer are approved for both manic and mixed episodes, fewer still for maintenance treatment, and only two for the treatment of acute bipolar depression [1,2].…”

Mood-Stabilizing Agents

“…For lithium, anticonvulsants, and antipsychotics, there is a substantial literature arising from reports of randomized, controlled trials in acute mania ( Fig. 3.3 , Table 3.5 ) [ 79,193,325,373 ] . Lithium salts are relatively speci fi c for the treatment of mania but their latency to useful clinical effects is relatively long (5-10 days), and potential toxicity limits the feasibility of rapid dose increases.…”