title: Systematic review of cholinergic drugs for neuroleptic-induced tardive dyskinesia: a meta-analysis of randomized controlled trials.
abstract: The authors evaluated the efficacy of cholinergic drugs in the treatment of neuroleptic-induced tardive dyskinesia (TD) by a systematic review of the literature on the following agents: choline, lecithin, physostigmine, tacrine, 7-methoxyacridine, ipidacrine, galantamine, donepezil, rivastigmine, eptastigmine, metrifonate, arecoline, RS 86, xanomeline, cevimeline, deanol, and meclofenoxate. All relevant randomized controlled trials, without any language or year limitations, were obtained from the Cochrane Schizophrenia Group's Register of Trials. Trials were classified according to their methodological quality. For binary and continuous data, relative risks (RR) and weighted or standardized mean differences (SMD) were calculated, respectively. Eleven trials with a total of 261 randomized patients were included in the meta-analysis. Cholinergic drugs showed a minor trend for improvement of tardive dyskinesia symptoms, but results were not statistically significant (RR 0.84, 95% confidence interval (CI) 0.68 to 1.04, p=0.11). Despite an extensive search of the literature, eligible data for the meta-analysis were few and no results reached statistical significance. In conclusion, we found no evidence to support administration of the old cholinergic agents lecithin, deanol, and meclofenoxate to patients with tardive dyskinesia. In addition, two trials were found on novel cholinergic Alzheimer drugs in tardive dyskinesia, one of which was ongoing. Further investigation of the clinical effects of novel cholinergic agents in tardive dyskinesia is warranted.
authors.affiliation: Department of Psychiatry, University of Helsinki, Helsinki University Central Hospital, P.O. Box 320, FIN-00029, Finland.
authors.forename: Irina A
authors.initials: IA
authors.lastname: Tammenmaa
authors.forename: Eila
authors.initials: E
authors.lastname: Sailas
authors.forename: John J
authors.initials: JJ
authors.lastname: McGrath
authors.forename: Karla
authors.initials: K
authors.lastname: Soares-Weiser
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
mesh_terms: D000328:Adult; D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D018678:Cholinergic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D014150:Antipsychotic Agents; D018678:Cholinergic Agents