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Systematic review and meta-analysis
Meta-analysis of the Efficacy and Safety of Adjunctive Rosuvastatin for Dyslipidemia in Patients with Schizophrenia
  1. Wei Zheng1,
  2. Wei Yang2,
  3. Qing-E Zhang3,
  4. Xin-Hu Yang1,
  5. Dong-Bin Cai4,
  6. Jin-Qing Hu1,
  7. Gabor S. Ungvari5,
  8. Chee H. Ng6,
  9. Marc De Hert7,
  10. Yu-Ping Ning1 and
  11. Yu-Tao Xiang8
  1. 1The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
  2. 2Xiamen Xian Yue Hospital, Xiamen, Fujian, China
  3. 3The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
  4. 4Clinics of Chinese Medicine, the First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
  5. 5The University of Notre Dame Australia / Marian Centre & Graylands Hospital, Perth, Australia
  6. 6Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
  7. 7Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium, Department of Neurosciences KU Leuven, Belgium
  8. 8Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
  1. correspondence: Dr. Yu-Tao Xiang. Mailing address: 3/F, Building E12, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China. E-mail: xyutly{at}gmail.com; & Dr. Yu-Ping Ning. Mailing address: the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China. Postcode: 510370. E-mail: ningjeny{at}126.com

Abstract

Background Metabolic syndrome in patients with schizophrenia is a major health concern. The efficacy and safety of adjunctive rosuvastatin in treating dyslipidemia were controversial.

Aims To assess the efficacy and safety of adjunctive rosuvastatin for dyslipidemia in patients with schizophrenia.

Methods We systematically searched for relevant controlled clinical trials from the following databases: PubMed, PsycINFO, Cochrane Library, China Knowledge Network, WanFang Database and Chinese Biomedical Database up to September 28, 2017. Standardized mean difference (SMD) and risk ratio (RR) along with their 95% confidence intervals (CIs) were calculated. The quality of the included studies was assessed using the Cochrane risk of bias assessment tool. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system recommendation grading method was used as the reference standard.

Results Four studies (n=274) comparing rosuvastatin (n=138) and control (n=136) groups were identified and analyzed. Adjunctive rosuvastatin showed greater efficacy than control group in low density lipoprotein cholesterol (LDL-C) [4 trials, n=272, SMD: -1.31 (95%CI: -1.93, -0.70), I2=81%], total cholesterol (2 trials, n=164, SMD: -2.00 (95%CI: -2.79, -1.21); I2=76%) and triglycerides (2 trials, n=164, SMD: -1.05 (95%CI: -1.38, -0.72); I2=0%), but not in high density lipoprotein cholesterol (2 trials, n=164, SMD: 0.14 (95%CI: -0.16, 0.45); I2=0%). After removing one study without randomization for LDL-C, significance remained [3 trials, n=172, SMD:-1.07 (95%CI: -1.60, -0.53); I2=63%]. No significant group differences regarding body weight (3 trials, n=208, SMD: -0.40 (95%CI:-1.29, 0.49); I2=89%), body mass index (2 trials, n=164, SMD: -0.34 (95%CI: -1.23, 0.56); I2=87%), waist circumference (3 trials, n=208, SMD: -0.43 (95%CI: -1.31, 0.46); I2=89%), and fasting glucose (4 trials, n=272, SMD: -0.25 (95%CI: -0.65, 0.15); I2=62%) were observed. The adverse reactions and any cause discontinuation rate were similar between the groups. According to the GRADE approach, the evidence levels of main outcomes were rated as “very low” (35.3%) to “low” (64.7%). Of them, the primary outcome (LDL-C) was rated as “very low”.

Conclusions The data available on the effectiveness and safety of adjunctive rosuvastatin in treating dyslipidemia for patients with schizophrenia is insufficient to come to a definitive interpretation about its efficacy and safety. Further high quality RCTs with extended treatment duration are warranted to confirm the findings.

Review registration PROSPERO: CRD42017078230

  • schizophrenia
  • rosuvastatin
  • dyslipidemia
  • low density lipoprotein cholesterol
  • 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.11919/j.issn.1002-0829.217156

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