Selective Serotonin 3 Receptor Antagonist Treatment for Schizophrenia: Meta-analysis and Systematic Review

Double-blinded, randomized, placebo-control trials of selective serotonin 3 receptor antagonists (5-HT₃R-ANTs) for schizophrenia have differed in outcome. This meta-analysis tests the hypothesis that 5-HT₃R-ANTs are effective for the treatment for schizophrenia. We searched PubMed, the Cochrane Library database, and PsycINFO up to June 15, 2013. We conducted a systematic review and meta-analysis of individual patient data from randomized controlled trials comparing 5-HT₃R-ANTs add-on therapy with placebo. The risk ratio (RR), 95 % confidence intervals (CI), and standardized mean difference (SMD) were calculated. A random-effects model was used. Six studies (total n = 311) were identified. These included one granisetron plus risperidone study, one ondansetron plus risperidone study, one ondansetron plus haloperidol, and three tropisetron plus risperidone studies. The statistically significant effects of 5-HT₃R-ANTs add-on therapy on Positive and Negative Syndrome Scale (PANSS) total scores were SMD = −1.03, CI = −1.70 to −0.36, p = 0.003 (I ² = 82 %, 5 studies, n = 261); on negative scores were SMD = −1.10, CI = −1.82 to −0.39, p = 0.002 (I ² = 84 %, 5 studies, n = 261); and on PANSS general scores were SMD = −0.70, CI = −1.23 to −0.17, p = 0.01 (I ² = 73 %, 5 studies, n = 261). However, 5-HT₃R-ANTs add-on therapy was not superior to placebo in PANSS positive scores (SMD = −0.12, p = 0.33). Dropout due to all cause (RR = 0.80, p = 0.50), inefficacy (RR = 0.76, p = 0.65), or adverse events (RR = 0.84, p = 0.75) was similar in both groups. Constipation occurred significantly more often with 5-HT₃R-ANTs than placebo (RR = 2.05, CI = 1.07–3.91, p = 0.03, NNH = 11, p = 0.02). 5-HT₃R-ANTs add-on therapy is more beneficial on the psychopathology (especially negative symptoms) than controls in patients with schizophrenia, and 5-HT₃R-ANTs seem to be well-tolerated treatments.