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Systematic review
Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia: a meta-analysis of randomised controlled trials
  1. Wei Zheng1,
  2. Dong-Bin Cai2,
  3. Hai-Yan Li1,
  4. Yu-Jie Wu1,
  5. Chee H Ng3,
  6. Gabor S Ungvari4,5,
  7. Shan-Shan Xie6,
  8. Zhan-Ming Shi7,
  9. Xiao-Min Zhu8,
  10. Yu-Ping Ning1 and
  11. Yu-Tao Xiang9
  1. 1 Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
  2. 2 Department of Neurology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
  3. 3 Department of Psychiatry, University of Melbourne, Melbourne, Australia
  4. 4 The University of Notre Dame Australia, Fremantle, Australia
  5. 5 Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
  6. 6 Department of Psychiatry, Mental Health Center of Hebei Province, Baoding, China
  7. 7 Department of Psychiatry, Chongqing Jiangbei Mental Health Hospital, Chongqing, China
  8. 8 Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
  9. 9 Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau, China
  1. Correspondence to Dr Yu-Tao Xiang; xyutly{at}gmail.com

Abstract

Background Hyperprolactinaemia is a common adverse effect of antipsychotics (APs). The results of Peony-Glycyrrhiza decoction (PGD) as a potentially useful adjunctive treatment for hyperprolactinaemia are inconsistent.

Aim This meta-analysis of randomised controlled trials (RCTs) examined the efficacy and safety of adjunctive PGD therapy for AP-induced hyperprolactinaemia.

Methods English (PubMed, Embase, Cochrane Library, PsycINFO) and Chinese (Chinese National Knowledge Infrastructure, Wanfang Data) databases were systematically searched up to 10 June 2018. The inclusion criteria were based on PICOS—Participants: adult patients with schizophrenia; Intervention: PGD plus APs; Comparison: APs plus placebo or AP monotherapy; Outcomes: efficacy and safety; Study design: RCTs. The weighted mean difference (WMD) and risk ratio (RR) along with their 95% CIs were calculated using Review Manager (RevMan) V.5.3 software.

Results Five RCTs (n=450) were included and analysed. Two RCTs (n=140) were double-blind and four RCTs (n=409) reported ‘random’ assignment with specific description. The PGD group showed a significantly lower serum prolactin level at endpoint than the control group (n=380, WMD: −32.69  ng/mL (95%  CI −41.66 to 23.72), p<0.00001, I 2=97%). Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale (n=403, WMD: −0.62 (95% CI −2.38 to 1.15), p=0.49, I 2=0%). There were similar rates of all-cause discontinuation (n=330, RR 0.93 (95% CI 0.63 to 1.37), p=0.71, I 2=0%) and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ (14.3%), ‘low’ (42.8%), ‘moderate’ (14.3%), to ‘high’ (28.6%).

Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without significant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confirm these findings.

Trial registration number 42016037017.

  • prolactin
  • peony-glycyrrhiza decoction
  • antipsychotics
  • meta-analysis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/gpsych-2018-100003

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    Footnotes

    • WZ and D-BC contributed equally.

    • Contributors WZ and Y-TX designed the study and were assisted by D-BC in the search for papers, data extraction and analysis. WZ and D-BC drafted the manuscript. GSU, CHN and Y-TX made critical revisions to the manuscript. All authors approved the final version for publication.

    • Funding The study was supported by the University of Macau (SRG2014-00019-FHS; MYRG2015-00230 FHS; MYRG2016-00005-FHS) and the Affiliated Brain Hospital of Guangzhou Medical University (2016YFC0906302; 81671334; 2014Y2-00105; 2015BAI13B02). The University of Macau and the Affiliated Brain Hospital of Guangzhou Medical University had no role in the study design, generation or interpretation of the results, and publication of the study.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data statement All the relevant data has been presented in Tables and Figures.