Question Are antipsychotic dose equivalents between acute mania and schizophrenia the same? Study selection and analysis Six databases were systematically searched (from inception to 17 September 2022) to identify blinded randomised controlled trials (RCTs) that used a flexible-dose oral antipsychotic drug for patients with acute mania. The mean and SD of the effective dose and the pre–post changes in manic symptoms were extracted. A network meta-analysis (NMA) under a frequentist framework was performed to examine the comparative efficacy between the antipsychotics. A classic mean dose method (sample size weighted) was used to calculate each antipsychotic dose equivalent to 1 mg/day olanzapine for acute mania. The antipsychotic dose equivalents of acute mania were compared with published data for schizophrenia. Findings We included 42 RCTs which enrolled 11 396 participants with acute mania. The NMA showed that risperidone was superior to olanzapine (reported standardised mean difference: −022, 95% CI −0.41 to –0.02), while brexpiprazole was inferior to olanzapine (standardised mean difference: 0.36, 95% CI 0.08 to 0.64). The dose equivalents to olanzapine (with SD) were 0.68 (0.23) for haloperidol, 0.32 (0.07) for risperidone, 0.60 (0.11) for paliperidone, 8.00 (1.41) for ziprasidone, 41.46 (5.98) for quetiapine, 1.65 (0.32) for aripiprazole, 1.23 (0.20) for asenapine, 0.53 (0.14) for cariprazine and 0.22 (0.03) for brexpiprazole. Compared with the olanzapine dose equivalents for schizophrenia, those of acute mania were higher for quetiapine (p<0.001, 28.5%) and aripiprazole (p<0.001, 17.0%), but lower for haloperidol (p<0.001, –8.1%) and risperidone (p<0.001, –15.8%). Conclusions Antipsychotic drugs have been considered first-line treatment for acute mania, warranting specific dose equivalence for scientific and clinical purposes. Data are available upon reasonable request.

中文翻译：

---

急性双相躁狂和精神分裂症抗精神病药物剂量当量的比较

问题 急性躁狂症和精神分裂症之间的抗精神病药剂量当量相同吗？研究选择和分析系统地检索了六个数据库（从开始到 2022 年 9 月 17 日），以确定使用灵活剂量口服抗精神病药物治疗急性躁狂症患者的盲法随机对照试验 (RCT)。提取有效剂量的平均值和标准差以及躁狂症状的前后变化。在频率论框架下进行了网络荟萃分析（NMA），以检查抗精神病药物之间的比较疗效。使用经典的平均剂量方法（样本量加权）计算相当于 1 毫克/天奥氮平治疗急性躁狂症的每种抗精神病药物剂量。将急性躁狂症的抗精神病药物剂量当量与已发表的精神分裂症数据进行比较。结果 我们纳入了 42 项随机对照试验，纳入了 11 396 名患有急性躁狂症的参与者。NMA 显示，利培酮优于奥氮平（报告标准化平均差：-022，95% CI -0.41 至 –0.02），而布瑞哌唑劣于奥氮平（标准化平均差：0.36，95% CI 0.08 至 0.64）。奥氮平的剂量当量（SD）为氟哌啶醇 0.68（0.23）、利培酮 0.32（0.07）、帕潘立酮 0.60（0.11）、齐拉西酮 8.00（1.41）、喹硫平 41.46（5.98）、利培酮 1.65（0.32）阿立哌唑，阿塞那平为 1.23 (0.20)，卡利拉嗪为 0.53 (0.14)，布瑞哌唑为 0.22 (0.03)。与精神分裂症的奥氮平剂量当量相比，喹硫平（p<0.001，28.5%）和阿立哌唑（p<0.001，17.0%）的急性躁狂剂量当量较高，但氟哌啶醇（p<0.001，–8.1%）和阿立哌唑的急性躁狂剂量当量较低。利培酮（p<0.001，–15.8%）。结论 抗精神病药物被认为是急性躁狂症的一线治疗药物，出于科学和临床目的，需要特定的剂量当量。数据可根据合理要求提供。