Tardive Dyskinesia Prevalence in the Period of Second-Generation Antipsychotic Use: A Meta-Analysis.
OBJECTIVE
Comparison of tardive dyskinesia (TD) prevalence during contemporaneous treatment with first-generation antipsychotics (FGAs) and/or second-generation antipsychotics (SGAs).


METHODS
PubMed/MEDLINE/Google Scholar search (January 1, 2000-September 30, 2015) without language restriction using (tardive dyskinesia OR tardive) AND (antipsychotic*) plus specific names of SGAs.


METHODS
Of 8,895 hits, we screened 203 full-text articles for cross-sectional, rating scale-based TD rates during SGA, FGA, or FGA+SGA treatment. Forty-one studies were used for random effects meta-analysis and meta-regression.


METHODS
Two authors independently extracted data on overall and antipsychotic class-wise TD rates and on TD moderators.


RESULTS
The global mean TD prevalence was 25.3% (95% CI = 22.7%-28.1%) across all 41 studies (N = 11,493, mean age = 42.8 years, male = 66.4%, schizophrenia-spectrum disorders = 77.1%). TD prevalence varied greatly: Rates were lower with current SGA treatment (20.7%; 95% CI = 16.6%-25.4%, N = 5,103) vs current FGA treatment (30.0%; 95% CI = 26.4%-33.8%, N = 5,062; Q = 9.17, P = .002). This difference remained significant after controlling for moderators: higher age (Z = 2.85, P = .004; number of studies = 39 ) and region (39 studies; Asia vs Europe, Z = 1.55, P = .12; Asia lower than United States, Z = 2.6, P = .009; Asia lower than other regions, Z = 2.42, P = .015). Additional moderators of TD prevalence included longer illness duration (R² = 0.15; P = .03; 21 studies) and frequency of parkinsonism (R² = 0.23, P = .017; number of studies = 19). Particularly low TD prevalence (7.2%; number of studies = 4) was found in the treatment arms with FGA-naive subjects relative to SGA-treated cohorts with likely prior FGA exposure (23.4%; P < .001; 28 studies). Lower TD prevalence of SGA relative to FGA was also confirmed in the subgroup of studies reporting on ≥ 2 antipsychotic classes/combinations; this was found for both SGAs vs FGAs (risk ratio = 0.80; 95% CI = 0.67-0.95, Z = -2.55, P = .011) and FGA + SGA vs FGAs (risk ratio = 0.80, 95% CI = 0.71-0.90, Z = -3.56, P < .001). Reports on TD severity, provided by 10 studies, were of insufficient quality for meta-analysis.


CONCLUSIONS
Rating scale-based TD remains highly prevalent, with higher rates during FGA than during SGA treatment. However, TD severity was insufficiently reported to allow for interpretation of the clinical impact of identified TD cases with SGAs and FGAs. Reasons for high geographical variation warrant future research.
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.
Maren
M
Carbon
Division of Psychiatry, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan.
Cheng-Hsi
CH
Hsieh
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.|Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.|Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, USA.
John M
JM
Kane
Zucker Hillside Hospital, Psychiatry Research, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004. ccorrell@northwell.edu.|Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.|Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.|Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, USA.
Christoph U
CU
Correll
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D006801:Humans; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D000071057:Tardive Dyskinesia / Q000453:epidemiology* / Q000517:prevention & control
D014150:Antipsychotic Agents