title: Systematic review: pharmacological treatment of tic disorders--efficacy of antipsychotic and alpha-2 adrenergic agonist agents.
abstract: We conducted a meta-analysis of randomized, placebo-controlled trials to determine the efficacy of antipsychotic and alpha-2 agonists in the treatment of chronic tic disorders and examine moderators of treatment effect. Meta-analysis demonstrated a significant benefit of antipsychotics compared to placebo (standardized mean difference (SMD)=0.58 (95% confidence interval (CI): 0.36-0.80). Stratified subgroup analysis found no significant difference in the efficacy of the 4 antipsychotic agents tested (risperidone, pimozide, haloperidol and ziprasidone). Meta-analysis also demonstrated a benefit of alpha-2 agonists compared to placebo (SMD=0.31 (95% confidence interval CI: 0.15-0.48). Stratified subgroup analysis and meta-regression demonstrated a significant moderating effect of co-occurring ADHD. Trials which enrolled subjects with tics and ADHD demonstrated a medium-to-large effect (SMD=0.68 (95%CI: 0.36-1.01) whereas trials that excluded subjects with ADHD demonstrated a small, non-significant benefit (SMD=0.15 (95%CI: -0.06 to 0.36). Our findings demonstrated significant benefit of both antipsychotics and alpha-2 agonists in treating tics but suggest alpha-2 agonists may have minimal benefit in tic patients without ADHD.
authors.affiliation: Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06520, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Weisman
authors.forename: Imraan A
authors.initials: IA
authors.lastname: Qureshi
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
authors.forename: Lawrence
authors.initials: L
authors.lastname: Scahill
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000367:Age Factors; D000818:Animals; D000930:Antidiarrheals / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000209:etiology; D002986:Clinical Trials as Topic; D006801:Humans; D015201:Meta-Analysis as Topic; D039781:PubMed / Q000706:statistics & numerical data; D013981:Tic Disorders / Q000150:complications / Q000188:drug therapy*
chemical_list: D000316:Adrenergic alpha-Agonists; D000930:Antidiarrheals