Oral fluphenazine versus placebo for schizophrenia.
BACKGROUND
Fluphenazine is one of the first drugs to be classed as an 'antipsychotic' and has been widely available for five decades.


OBJECTIVE
To evaluate the effects of oral fluphenazine for schizophrenia in comparison with placebo.


METHODS
We searched the Cochrane Schizophrenia Group's trials register (September 2006) which includes relevant randomised controlled trials from the bibliographic databases Biological Abstracts, CINAHL, The Cochrane Library, EMBASE, MEDLINE, PsycLIT, LILACS, PSYNDEX, Sociological Abstracts and Sociofile. References of all identified studies were searched for further trial citations.


METHODS
We sought all randomised controlled trials comparing oral fluphenazine with placebo relevant to people with schizophrenia. Primary outcomes of interest were global state and adverse effects.


METHODS
We inspected citations and abstracts independently, ordered papers and re-inspected and quality assessed trials. We extracted data independently. Dichotomous data were analysed using fixed effects relative risk (RR) and the 95% confidence interval (CI). Continuous data were excluded if more than 50% of people were lost to follow up, but, where possible, weighted mean differences (WMD) were calculated.


RESULTS
We found over 1200 electronic records for 415 studies, 47 of which were relevant but only seven could be included. Compared with placebo, in the short-term, global state outcomes for 'not improved' were not significantly different (n=75, 2 RCTs, RR 0.71 CI 0.5 to 1.1). There is evidence that oral fluphenazine, in the short term, increases a person's chances of experiencing extrapyramidal effects such as akathisia (n=227, 2 RCTs, RR 3.43 CI 1.2 to 9.6, NNH 13 CI 4 to 128) and rigidity (n=227, 2 RCTs, RR 3.54 CI 1.8 to 7.1, NNH 6 CI 3 to 17). We found study attrition to be lower in the oral fluphenazine group, but data were not statistically significant (n=227, 2 RCTs, RR 0.70 CI 0.4 to 1.1).


CONCLUSIONS
The findings in this review confirm much that clinicians and recipients of care already know, but they provide quantification to support clinical impression. Fluphenazine's global position as an effective treatment for psychoses is not threatened by the outcome of this review. However, fluphenazine is an imperfect treatment and If accessible, other inexpensive drugs less associated with adverse effects may be an equally effective choice for people with schizophrenia.
Matar
H E
HE
Damascus School of Medicine, Khabani Road 2789/FW17, P.O Box: 11719, Damascus, Syria. hematar@hotmail.co.uk
Almerie
M Q
MQ
D000284:Administration, Oral; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D005476:Fluphenazine / Q000627:therapeutic use*; D006801:Humans; D010919:Placebos / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000188:drug therapy*
D014150:Antipsychotic Agents; D010919:Placebos; D005476:Fluphenazine