Background Antipsychotics are the treatment of choice for schizophrenia, but they often induce akathisia. However, comparative efficacy of treatment strategies for akathisia remains unclear. Design We performed a systematic review and network meta-analyses (PROSPERO CRD42023450720). We searched multiple databases on July 24, 2023. We included randomized clinical trials comparing 1 or more treatment strategies for antipsychotic-induced akathisia against each other or control conditions. We included adults with schizophrenia or other psychiatric disorders treated with antipsychotics. The primary outcome was akathisia severity at posttreatment. Secondary outcomes included akathisia response, all-cause dropout, psychotic symptoms, and long-term akathisia severity. We synthesized data in random effects frequentist network meta-analyses and assessed confidence in the evidence using CINeMA. Results We identified 19 trials with 661 randomized participants (mean age 35.9 [standard deviation 12.0]; 36.7% [195 of 532] women). No trials examined dose reduction or switching of antipsychotics. Findings suggested 5-HT2A antagonists (k = 6, n = 108; standardized mean difference [SMD] −1.07 [95% confidence interval, −1.42; −0.71]) and beta-blockers (k = 8, n = 105; SMD −0.46 [−0.85; −0.07]) may improve akathisia severity, but confidence in the evidence was deemed low. We also found that benzodiazepines (k = 2, n = 13; SMD −1.62 [−2.64; −0.59]) and vitamin B6 (k = 3, n = 67; SMD −0.99 [−1.49; −0.50]) might also be beneficial, but confidence in the evidence was very low. Analyses of secondary outcomes did not provide additional insights. Conclusions Our findings suggest that 5-HT2A antagonists, beta-blockers, and with a lesser certainty, benzodiazepines, and vitamin B6 might improve akathisia. Given the low to very low confidence in the evidence of add-on agents and the absence of evidence of their long-term efficacy, careful consideration of side effects is warranted. These recommendations are extremely preliminary and further trials are needed.

中文翻译：

---

抗精神病药物引起的静坐不能治疗策略的比较疗效和可接受性：系统评价和网络荟萃分析


背景 抗精神病药物是精神分裂症的首选治疗方法，但它们经常诱发静坐不能。然而，静坐不能治疗策略的比较疗效仍不清楚。设计 我们进行了系统评价和网络荟萃分析 (PROSPERO CRD42023450720)。我们于 2023 年 7 月 24 日检索了多个数据库。我们纳入了随机临床试验，将一种或多种抗精神病药物引起的静坐不能的治疗策略相互或对照条件进行比较。我们纳入了患有精神分裂症或接受抗精神病药物治疗的其他精神疾病的成年人。主要结局是治疗后静坐不能的严重程度。次要结局包括静坐不能反应、全因退出、精神病症状和长期静坐不能严重程度。我们综合了随机效应频率网络荟萃分析中的数据，并使用 CINeMA 评估了证据的可信度。结果 我们确定了 19 项试验，共有 661 名随机参与者（平均年龄 35.9 岁 [标准差 12.0]；36.7% [532 名中的 195 名] 为女性）。没有试验检查抗精神病药物的剂量减少或转换。研究结果表明 5-HT2A 拮抗剂（k = 6，n = 108；标准化平均差 [S​​MD] -1.07 [95% 置信区间，-1.42；-0.71]）和 β 受体阻滞剂（k = 8，n = 105；SMD） −0.46 [−0.85; −0.07]）可能会改善静坐不能的严重程度，但证据可信度较低。我们还发现苯二氮卓类药物 (k = 2, n = 13; SMD −1.62 [−2.64; −0.59]) 和维生素 B6 (k = 3, n = 67; SMD −0.99 [−1.49; −0.50]) 也可能具有是有益的，但证据的可信度很低。对次要结果的分析没有提供额外的见解。 结论 我们的研究结果表明，5-HT2A 拮抗剂、β 受体阻滞剂以及（不确定性较低）苯二氮卓类药物和维生素 B6 可能会改善静坐不能。鉴于对附加药物证据的置信度从低到极低，并且缺乏其长期疗效的证据，因此有必要仔细考虑副作用。这些建议是非常初步的，需要进一步的试验。