Evidence on antipsychotic drug treatment for schizophrenia from Western and Chinese trials: building a joint database and applying network meta-analyses

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Schizophrenia ranks among the most debilitating disorders according to the World Health Report. It leads to a dramatic burden for patients, relatives and society. Multiple antipsychotic drugs are available for its treatment which differ enormously in their multiple side-effects, but probably also efficacy. These agents have been compared in hundreds of randomised-controlled trials. These high numbers make special statistical techniques – so- called network meta-analyses – necessary to synthesize the data and to come up with objective conclusions about the relative effects of these compounds. Network meta-analysis also allows to produce hierarchies about which is the best drug, the second best and so on in a specific outcome. The Chinese and the German partner have collaborated in the area of evidence-based medicine in schizophrenia for many years, and they both serve as editors to the Cochrane Schizophrenia Group. Thus, both are methodological experts in evidence-based medicine. Moreover, the German partner has set up a preliminary meta-analytic of schizophrenia studies. However, this database needs to be updated, and expanded to new drugs and the inclusion of further outcomes. Studies from China which currently produces approximately 25% of the randomised trials in this area have to date not been included. This gap is a major limitation, because it is fundamental in evidence-based medicine that all trials are included irrespectively of their origin. Reasons for this unfortunate situation are that most Chinese studies are not collected by international databases such as Pubmed, translation problems and differences in study quality. To include Chinese studies in large scale meta-analyses collaboration with an experienced Chinese team is therefore necessary. The aim of the proposal therefore is to provide a database of Western and Chinese randomised antipsychotic drug trials which have been extracted for meta-analysis. The team in Shanghai will be trained for this purpose by the Munich team in its exact methods as to how to select studies, evaluate their quality and extract the data. Such a standardization is essential for making its results comparable with those of the German team. The Shanghai team will assess the quality of the Chinese studies including direct contact with their authors. We expect that approximately 900 studies on approximately 30 antipsychotics will be included. Finally, comprehensive network meta-analyses on multiple efficacy and side- effect outcomes, including short-term and long-term treatment will be calculated. Hierarchies of the multiple antipsychotic drugs will be established which will inform clinicians, patients and policy makers on the effects of these drugs.