Clothiapine for acute psychotic illness: a meta-analysis

Objectives: To estimate the effects of clothiapine, a dibenzothiazepine neuroleptic, for the management of acute psychosis. Methods: Six databases were searched, reference lists were inspected and relevant industry and authors contacted. Randomised clinical trials involving clothiapine for acute psychosis were identified and relevant data extracted. Results: Five relevant trials were found comparing clothiapine with antipsychotics or lorazepam. We found no evidence to support or refute the use of clothiapine in the psychiatric emergency (no significant improvement compared with other antipsychotics RR 0.82, 95% CI 0.2 to 3.1, heterogeneous p=0.09, N=83; no difference in mental state change when clothiapine was compared to lorazepam WMD -3.36 95%CI -8.09 to 1.37, N=60). Clothiapine may result in less need for antiparkinsonian treatment than zuclopenthixol acetate (RR 0.43, 95%CI 0.02 to 0. 98, N=38). Conclusions: Wide confidence intervals prevent any firm conclusions, but clothiapine could be effective and cheap for rapid tranquillisation.